Predicting the outcome of surgical treatment of vulvar vestibulitis

https://doi.org/10.1016/S0029-7844(97)00102-6Get rights and content

Objective: To identify predictive factors for success or failure of perineoplasty for severe vulvar vestibulitis.

Methods: Seventy-nine women with severe vulvar vestibulitis underwent perineoplasty by a single surgeon during 1992–1994. Sixty (76%) who experienced a complete response were compared with 19 (24%) who had an incomplete response. Using univariate and then multivariate (logistic regression) analysis, the two groups were compared with regard to preoperative demographic, social, and medical variables, as well as physical findings in the vestibule.

Results: The complete- and incomplete-response groups were similar in all comparisons except for constant vulvar pain of vestibular origin (in addition to dyspareunia) and the presence of symptoms since first coitus. On multiple logistic regression, these characteristics had odds ratios (and 95% confidence intervals) of 4.97 (1.49, 16.63) and 5.83 (1.74, 19.55), respectively.

Conclusion: An incomplete response to perineoplasty may be anticipated in women with vulvar vestibulitis associated with dyspareunia since their first episode of intercourse and in those with associated persistent vulvar pain. Treatment approaches other than surgery should be considered for such patients.

References (19)

  • SC Marinoff et al.

    Vulvar vestibulitis

    Am J Obstet Gynecol

    (1991)
  • J Bornstein et al.

    Polymerase chain reaction search for viral etiology of vulvar vestibulitis syndrome

    Am J Obstet Gynecol

    (1996)
  • M Meana et al.

    Painful coitus: A review of female dyspareunia

    J Neuro Ment Dis

    (1994)
  • G Sandberg et al.

    Dyspareunia: An integrated approach to assessment and diagnosis

    J Fam Pract

    (1987)
  • AE Glatt et al.

    The prevalence of dyspareunia

    Obstet Gynecol

    (1990)
  • EG Friedrich

    Vulvar vestibulitis syndrome

    J Reprod Med

    (1987)
  • MS Baggish et al.

    Vulvar pain syndrome: A review

    Obstet Gynecol Surv

    (1995)
  • ID Woodruff et al.

    Treatment of dyspareunia and vaginal outlet distortion by perineoplasty

    Obstet Gynecol

    (1981)
  • J Bornstein et al.

    Treatment of intractable vulvar vestibulitis

    Isr J Obstet Gynecol

    (1994)
There are more references available in the full text version of this article.

Cited by (68)

  • Vulvodynia: Assessment and Treatment

    2016, Journal of Sexual Medicine
  • Are Primary and Secondary Provoked Vestibulodynia Two Different Entities? A Comparison of Pain, Psychosocial, and Sexual Characteristics

    2015, Journal of Sexual Medicine
    Citation Excerpt :

    A study on the multidisciplinary treatment for PVD showed that women with PVD2 were more likely to have major improvement compared with women with PVD1 [5]. Furthermore, previous research suggested that women with PVD2 respond better to vestibulectomy than women with PVD1 [15,16,20]. Published findings concerning sociodemographics, pain, sexual, and psychosocial aspects of these conditions have not necessarily mirrored the differences found in these biomedical studies.

  • Provoked Vestibulodynia-Medical Factors and Comorbidity Associated with Treatment Outcome

    2012, Journal of Sexual Medicine
    Citation Excerpt :

    Lower levels of anxiety and catastrophizing as well as higher pain self‐efficacy prior to treatment have been found to be associated with reduced coital pain and improved sexual function. Moreover, a diagnosis of secondary PVD as well as fewer other concomitant pain conditions such as headache, irritable bowel syndrome, and back pain have also been linked to better response to treatment [29-32]. The primary aims of this study were to identify variables associated with treatment outcome in women who had completed treatment for PVD and to explore possible correlations between general pain sensitivity, subgroup of PVD, anxiety, depression, and various other medical parameters to the degree of coital pain.

  • Introital primary and secondary dyspareunia: Multimodal clinical and surgical control

    2012, Sexologies
    Citation Excerpt :

    Gaunt et al., 2003, using failed medical management as an operative indication, described a high rate of vestibulectomy success in 38 patients over 42 (90%) with pain scores varying from 8.9 (3–13) in preoperative against 1.3 (0–8) in postoperative for improved patients, and 7.0 (3–10) preoperative against 7.3 (6–10) postoperative, in the no improvement patients (n = 4). The failure of primary vestibulodynia control has been observed by Bornstein et al. (1997) in the association of spontaneous and provoked vestibulodynia patients. He invoked different aetiology for secondary vestibulodynia, namely acquired sexual viral and bacterial infections.

View all citing articles on Scopus
View full text