is recommended as a last resort when distinct mucosal involvement occurs.
The difference is probably unimportant in clinical practice, except that vestibulodynia can be treated with vestibulectomy
If vaginismus is present, treat that before sending the patient to vestibulectomy
, which may alleviate symptoms in 60%-85% of cases.
resulted in approximately twice the pain reduction of the two other treatments.
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).
A 25-year-old GOP0 woman underwent vestibulectomy
for primary provoked vestibulodynia followed by pelvic floor muscle physical therapy for primary vaginismus.
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.
In many women, however, vestibulectomy
is required to eliminate symptoms.
Of the 81 patients who did not respond within 6 months to conservative treatment, 56 agreed to undergo vulvar vestibulectomy
So the only thing that separates vestibulodynia from other patterns of vulvodynia is the option of 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.
I find that many women with vestibulodynia opt to try an injection before proceeding to vestibulectomy