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]
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.
Complicationsedit
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, or 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]
Recoveryedit
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]
Epidemiologyedit
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]
Referencesedit
^ abRosen, 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. S2CID 73485304.
^"Vulvodynia and vestibulodynia | Skin Support". skinsupport.org.uk. Retrieved 2018-10-27.
^. Austin Urogynecology. 2015-02-10. Archived from the original on 2018-10-28. Retrieved 2018-10-27.
^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.
^Bautrant, Eric; Porta, Oriol; Murina, Filippo; Mühlrad, Hanna; Levêque, Christine; Riant, Thibaut; Ploteau, Stephane; Valancogne, Guy; Levesque, Amélie (2019-10-01). "Provoked vulvar vestibulodynia: Epidemiology in Europe, physio-pathology, consensus for first-line treatment and evaluation of second-line treatments". Journal of Gynecology Obstetrics and Human Reproduction. 48 (8): 685–688. doi:10.1016/j.jogoh.2019.04.011. ISSN 2468-7847. PMID 31051298. S2CID 145024370.
^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.
^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. S2CID 19466615.
^Williams gynecology. Barbara L. Hoffman, J. Whitridge Williams (2nd ed.). New York: McGraw-Hill Medical. 2012. p. 1070. ISBN978-0-07-171672-7. OCLC 779244257.{{cite book}}: CS1 maint: others (link)
^"Vestibulectomy | San Diego Sexual Medicine". www.sandiegosexualmedicine.com. Retrieved 2018-10-27.
^Haefner, Hope K.; Collins, Michael E.; Davis, Gordon D.; Edwards, Libby; Foster, David C.; Hartmann, Elizabeth (Dee) Heaton; Kaufman, Raymond H.; Lynch, Peter J.; Margesson, Lynette J.; Moyal-Barracco, Micheline; Piper, Claudia K. (2005). "The Vulvodynia Guideline". Journal of Lower Genital Tract Disease. 9 (1): 40–51. doi:10.1097/00128360-200501000-00009. ISSN 1089-2591. PMID 15870521. S2CID 18081230.
^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.
^Ventolini, Gary (2011). (PDF). Journal of Clinical Medicine Research. 3 (2): 59–64. doi:10.4021/jocmr526w. PMC3140924. PMID 21811531. Archived from the original (PDF) on 2017-08-09.
^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. hdl:2027.42/74334. PMID 16942537. S2CID 25781480.
External resourcesedit
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January 01, 1970
vestibulectomy, vestibulectomy, gynecological, surgical, procedure, that, used, treat, vulvar, pain, specifically, cases, provoked, vestibulodynia, vestibulodynia, vulvar, vestibulitis, chronic, pain, syndrome, that, subtype, localized, vulvodynia, where, chro. 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 Contents 1 Procedure 2 Complications 3 Recovery 4 Epidemiology 5 References 6 External resourcesProcedure editThe 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 editComplications 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 or 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 editThe 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 editIn 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 edit a b 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 S2CID 73485304 Vulvodynia and vestibulodynia Skin Support skinsupport org uk Retrieved 2018 10 27 Vulvar Vestibulitis Austin Urogynecology Austin Urogynecology 2015 02 10 Archived from the original on 2018 10 28 Retrieved 2018 10 27 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 Bautrant Eric Porta Oriol Murina Filippo Muhlrad Hanna Leveque Christine Riant Thibaut Ploteau Stephane Valancogne Guy Levesque Amelie 2019 10 01 Provoked vulvar vestibulodynia Epidemiology in Europe physio pathology consensus for first line treatment and evaluation of second line treatments Journal of Gynecology Obstetrics and Human Reproduction 48 8 685 688 doi 10 1016 j jogoh 2019 04 011 ISSN 2468 7847 PMID 31051298 S2CID 145024370 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 Tommola Paivi 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 S2CID 19466615 Williams gynecology Barbara L Hoffman J Whitridge Williams 2nd ed New York McGraw Hill Medical 2012 p 1070 ISBN 978 0 07 171672 7 OCLC 779244257 a href Template Cite book html title Template Cite book cite book a CS1 maint others link Vestibulectomy San Diego Sexual Medicine www sandiegosexualmedicine com Retrieved 2018 10 27 Haefner Hope K Collins Michael E Davis Gordon D Edwards Libby Foster David C Hartmann Elizabeth Dee Heaton Kaufman Raymond H Lynch Peter J Margesson Lynette J Moyal Barracco Micheline Piper Claudia K 2005 The Vulvodynia Guideline Journal of Lower Genital Tract Disease 9 1 40 51 doi 10 1097 00128360 200501000 00009 ISSN 1089 2591 PMID 15870521 S2CID 18081230 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 a b Surgery for vulval pain Vulval Pain Society Vulval Pain Society Retrieved 2018 10 27 Ventolini Gary 2011 Measuring Treatment Outcomes in Women With Vulvodynia PDF Journal of Clinical Medicine Research 3 2 59 64 doi 10 4021 jocmr526w PMC 3140924 PMID 21811531 Archived from the original PDF on 2017 08 09 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 hdl 2027 42 74334 PMID 16942537 S2CID 25781480 External resources edit nbsp Wikimedia Commons has media related to Gynaecology Retrieved from https en wikipedia org w index php title Vestibulectomy amp oldid 1221031086, wikipedia, wiki, book, books, library,
