Medicine:Vestibulectomy

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Short description: Gynecological surgical procedure

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]

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, 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. ↑ 1.0 1.1 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. https://pubmed.ncbi.nlm.nih.gov/30847806. 
  2. ↑ "Vulvodynia and vestibulodynia | Skin Support" (in en). http://skinsupport.org.uk/conditions-details/vulvodynia-and-vestibulodynia. 
  3. ↑ "Vulvar Vestibulitis - Austin Urogynecology" (in en-US). Austin Urogynecology. 2015-02-10. https://www.austinurogynecology.com/vulvar-vestibulitis/. 
  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 et al. (2019-10-01). "Provoked vulvar vestibulodynia: Epidemiology in Europe, physio-pathology, consensus for first-line treatment and evaluation of second-line treatments" (in en). Journal of Gynecology Obstetrics and Human Reproduction 48 (8): 685–688. doi:10.1016/j.jogoh.2019.04.011. ISSN 2468-7847. PMID 31051298. https://www.sciencedirect.com/science/article/pii/S2468784719302429. 
  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. https://pubmed.ncbi.nlm.nih.gov/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. https://pubmed.ncbi.nlm.nih.gov/20955094. 
  8. ↑ Williams gynecology. Barbara L. Hoffman, J. Whitridge Williams (2nd ed.). New York: McGraw-Hill Medical. 2012. pp. 1070. ISBN 978-0-07-171672-7. OCLC 779244257. https://www.worldcat.org/oclc/779244257. 
  9. ↑ "Vestibulectomy | San Diego Sexual Medicine". http://www.sandiegosexualmedicine.com/female-treatments/vestibulectomy. 
  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. et al. (2005). "The Vulvodynia Guideline" (in en). Journal of Lower Genital Tract Disease 9 (1): 40–51. doi:10.1097/00128360-200501000-00009. ISSN 1089-2591. PMID 15870521. http://journals.lww.com/00128360-200501000-00009. 
  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. https://doi.org/10.1016/j.jmig.2013.12.077. 
  12. ↑ 12.0 12.1 "Surgery for vulval pain - Vulval Pain Society" (in en-GB). http://www.vulvalpainsociety.org/vps/index.php/treatments/surgery-for-vulval-pain. 
  13. ↑ Ventolini, Gary (2011). "Measuring Treatment Outcomes in Women With Vulvodynia". Journal of Clinical Medicine Research 3 (2): 59–64. doi:10.4021/jocmr526w. PMID 21811531. PMC 3140924. http://images.biomedsearch.com/21811531/jocmr-03-59.pdf?AWSAccessKeyId=AKIAIBOKHYOLP4MBMRGQ&Expires=1502409600&Signature=ZseYiGkvNY6AvXE%2Bfo%2BdRVluF%2Fk%3D. 
  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. PMID 16942537. 

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