is recommended as a last resort when distinct mucosal involvement occurs.
However, vestibulectomy resulted in approximately twice the pain reduction of the two other treatments.
A randomized comparison of group cognitive behavioral therapy, surface electromyographic biofeedback, and vestibulectomy in the treatment of dyspareunia resulting from vulvar vestibulitis," Pain 91 (2001):297-306.
But in a subsequent randomized trial comparing biofeedback with vestibulectomy
and cognitive-behavioral therapy, significant improvements in pain were seen in only 24% of the biofeed-back patients (Pain 91:297-306, 2001).
Patients with vestibulitis who don't respond to any of these approaches may wish to consider vestibulectomy
, which can be very effective in properly selected candidates.
Of the 81 patients who did not respond within 6 months to conservative treatment, 56 agreed to undergo vulvar vestibulectomy
Histologic evidence of lichenoid vulvar or vaginal disease was found in the majority of women who underwent vestibulectomy
for vulvar vestibulitis at a Milwaukee vulvar disease referral center.