Treatments with some proven efficacy are individual or group cognitive behavioural therapy (CBT), (3,4) pelvic floor physical therapy (5-7), and vestibulectomy
. (8,9) Medical management of vulvodynia presents a conspicuous gap in empirically validated recommendations.
In early glottic cancers, the addition of "vestibulectomy
," which was defined by Kashima et al.
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
Among women with severe localized pain, vestibulectomy
may be an effective measure for reducing vulvar pain intensity; however, pain reduction rates with this surgery have not been found to be different from medical management .
If vaginismus is present, treat that before sending the patient to vestibulectomy
, which may alleviate symptoms in 60%-85% of cases.
Surgical removal of the vestibule (vestibulectomy
) has been the most investigated treatment for VVS to date with more than 20 published outcome studies, yielding success rates ranging from 43-100%, with most of the rates typically surpassing 65-70%.
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).
Refractory and severe cases of vulvodynia can ultimately be managed surgically with the resection of vestibular tissues with posterior vaginal advancement flap (vestibulectomy
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.