Vestibulectomy

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A vestibulectomy is a gynecological surgical procedure that can be used to treat vulvar pain, specifically in cases of provoked vestibulodynia. Vestibulodynia (vulvar vestibulitis) is a chronic pain syndrome that is a subtype of localized vulvodynia [1] where chronic pain and irritation is present in the vulval vestibule, which is near the entrance of the vagina. [2] Vestibulectomy may be partial or complete. [3]

Contents

Vulvar vestibulectomy is primarily supported as an intervention for people who suffer from provoked vestibulodynia, which causes sexual pain to women. [4] It is not indicated as appropriate for people living with generalized vulvar pain disorders and non-provoked vestibulodynia. [1]

Vestibulectomy is not considered a first-line treatment option for provoked vestibulodynia, [5] but it is considered an effective treatment for the long-run and has recorded high levels of satisfaction from the patients. [6] One review found that significant pain relief was reported by 79% of patients. [7]

Procedure

The surgery takes place below the urinary meatus, down to the border of the perineal area and includes the fourchette. Incisions are made on each side adjacent and parallel to the labia minora. The structures removed are the hymen, mucous membrane, Bartholin glands ducts and minor vestibular glands. In some surgeries, the amount of tissue removed is not so extensive. Vaginal mucosa tissue remains attached and then is pulled downward to cover the area where tissue was removed. This surgery is also used to treat lichen sclerosus. [8] "The complete surgery removes the entire lateral hymenal tissues to the lateral vestibular walls at Hart’s line, and involves removal of the entire posterior fourchette from the posterior hymenal remnants down to the perineum" which barring complications, enables the entire procedure to be over within an hour. [9]

The procedure involves minimal bleeding and is usually done under spinal or general anesthesia. [10] The amount of tissue removed during the surgery can vary with respect to the pain.

Complications

Complications related to vestibulectomy include bleeding and infection. Long-term complications can be weakness of the anal muscles, cosmetic changes, development of a Bartholin's cyst, or a decline in vaginal lubrication. Reports of satisfaction with the outcome of the surgical procedure can be as high as 90%. [11]

The procedure has been known to be unsuccessful in rare cases, where the pain remained constant even after surgery. [12] In such cases, alternative treatments like oral medicines or more surgeries may be considered, depending on the severity of the persisting pain. [13]

Recovery

The recovery period is about 6–12 weeks, depending on the amount of vulvar tissues removed. Post-surgery, the patient might need further physical and possible mental therapy to avoid scarring and lead a regular sexual life. [12]

Epidemiology

In a study done in 2006, it was discovered that 93% of patients who had undergone the surgery recommended it for vulvar pain. Only 11% of women continued to have issues in their sex lives post-surgery. [14]

References

  1. 1 2 Rosen, Natalie O.; Dawson, Samantha J.; Brooks, Melissa; Kellogg-Spadt, Susan (2019). "Treatment of Vulvodynia: Pharmacological and Non-Pharmacological Approaches". Drugs. 79 (5): 483–493. doi:10.1007/s40265-019-01085-1. ISSN   1179-1950. PMID   30847806. S2CID   73485304.
  2. "Vulvodynia and vestibulodynia | Skin Support". skinsupport.org.uk. Retrieved 2018-10-27.
  3. "Vulvar Vestibulitis - Austin Urogynecology". Austin Urogynecology. 2015-02-10. Archived from the original on 2018-10-28. Retrieved 2018-10-27.
  4. Lavy, Yuval; Lev-Sagie, Ahinoam; Hamani, Yaron; Zacut, David; Ben-Chetrit, Avraham (2005-05-01). "Modified vulvar vestibulectomy: simple and effective surgery for the treatment of vulvar vestibulitis". European Journal of Obstetrics, Gynecology, and Reproductive Biology. 120 (1): 91–95. doi:10.1016/j.ejogrb.2004.04.039. ISSN   0301-2115. PMID   15866093.
  5. Bautrant, Eric; Porta, Oriol; Murina, Filippo; Mühlrad, Hanna; Levêque, Christine; Riant, Thibaut; Ploteau, Stephane; Valancogne, Guy; Levesque, Amélie (2019-10-01). "Provoked vulvar vestibulodynia: Epidemiology in Europe, physio-pathology, consensus for first-line treatment and evaluation of second-line treatments" . Journal of Gynecology Obstetrics and Human Reproduction. 48 (8): 685–688. doi:10.1016/j.jogoh.2019.04.011. ISSN   2468-7847. PMID   31051298. S2CID   145024370.
  6. Eva, Lois J.; Narain, Sumana; Orakwue, C. Obi; Luesley, David M. (2008). "Is modified vestibulectomy for localized provoked vulvodynia an effective long-term treatment? A follow-up study". The Journal of Reproductive Medicine. 53 (6): 435–440. ISSN   0024-7758. PMID   18664062.
  7. Tommola, Päivi; Unkila-Kallio, Leila; Paavonen, Jorma (2010). "Surgical treatment of vulvar vestibulitis: a review". Acta Obstetricia et Gynecologica Scandinavica. 89 (11): 1385–1395. doi:10.3109/00016349.2010.512071. ISSN   1600-0412. PMID   20955094. S2CID   19466615.
  8. Williams gynecology. Barbara L. Hoffman, J. Whitridge Williams (2nd ed.). New York: McGraw-Hill Medical. 2012. p. 1070. ISBN   978-0-07-171672-7. OCLC   779244257.{{cite book}}: CS1 maint: others (link)
  9. "Vestibulectomy | San Diego Sexual Medicine". www.sandiegosexualmedicine.com. Retrieved 2018-10-27.
  10. Haefner, Hope K.; Collins, Michael E.; Davis, Gordon D.; Edwards, Libby; Foster, David C.; Hartmann, Elizabeth (Dee) Heaton; Kaufman, Raymond H.; Lynch, Peter J.; Margesson, Lynette J.; Moyal-Barracco, Micheline; Piper, Claudia K. (2005). "The Vulvodynia Guideline". Journal of Lower Genital Tract Disease. 9 (1): 40–51. doi: 10.1097/00128360-200501000-00009 . ISSN   1089-2591. PMID   15870521. S2CID   18081230.
  11. Unger, C.A.; Kow, N.; Jelovsek, J. (2014). "Vestibulectomy: A Review of Technique" . Journal of Minimally Invasive Gynecology . 21 (2): S45. doi:10.1016/j.jmig.2013.12.077. ISSN   1553-4650.
  12. 1 2 "Surgery for vulval pain - Vulval Pain Society". Vulval Pain Society. Retrieved 2018-10-27.
  13. Ventolini, Gary (2011). "Measuring Treatment Outcomes in Women With Vulvodynia" (PDF). Journal of Clinical Medicine Research. 3 (2): 59–64. doi:10.4021/jocmr526w. PMC   3140924 . PMID   21811531. Archived from the original (PDF) on 2017-08-09.
  14. Goldstein, Andrew T.; Klingman, Daisy; Christopher, Kurt; Johnson, Crista; Marinoff, Stanley C. (2006). "ORIGINAL RESEARCH—SURGERY: Surgical Treatment of Vulvar Vestibulitis Syndrome: Outcome Assessment Derived from a Postoperative Questionnaire". The Journal of Sexual Medicine. 3 (5): 923–931. doi:10.1111/j.1743-6109.2006.00303.x. hdl: 2027.42/74334 . PMID   16942537. S2CID   25781480.

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