Vulvar vestibulitis treated by modified vestibulectomy

Objective: A prospective study to evaluate the success of a modified vestib ulectomy in treating vulvar vestibulitis. Methods: Fifty seven consecutive women with vulvar vestibulitis and suitable for surgery based on the criter ia: superficial dyspareunia, erythematous vestibular region, positive Q-tip test, symptoms reduced with local anesthetic cream. A modified vestibulect omy with or without a modified Fentons procedure was performed. Response wa s based on return to normal coitus, 3 months after surgery. Results: Most w omen suffered from chronic conditions (median duration of symptoms = 18 mon ths). The median age was 28 years (range 18-53). Any infections were treate d prior to surgery. All but 4 (7%) had histological abnormalities, mainly n on-specific inflammation. In 18% of women who had cervical cytology some ab normality was detected. Mean follow-up time was 12 months (range 2-42). Thr ee women were not evaluable. Complete response to surgery was achieved in 3 3 (61.1%) of the women, partial response was achieved in 15 (27.8%). Six (1 1.1%) had persistent symptoms, four of whom has psychosexual problems. Conc lusion: Presently, surgery remains the most successful intervention for vul var vestibulitis. Modified surgery which is less destructive seems to affor d acceptable results. The completion of randomized studies are needed to re cognise the optimum surgical procedure. (C) 1999 International Federation o f Gynecology and Obstetrics.