Vestibulectomy
Surgery is rarely indicated or offered in the management of vulval pain disorders.
In a select group of women with a diagnosis of localised provoked vulvodynia, however, a vestibulectomy has been useful in managing the condition and has been shown to have a success rate of up to 80% with careful patient selection.
Vestibulectomy is an operation that removes the lower vestibule (the skin around the opening of the lower half of the vagina). The aim is to remove hypersensitive tissue and replace it with advancement of normal vaginal skin. It involves making a V shaped incision at the bottom of the vagina. The operation is done under general anaesthesia, as a day case procedure. This means you go home the same day and there shouldn’t be a need for an overnight stay. The skin is closed with a combination of dissolvable and non-dissolvable stitches. It is common to have pain and discomfort for a few days or even weeks afterwards and you should take simple painkillers such as paracetamol and ibuprofen regularly until the pain eases.
All operations have some risks. After a vestibulectomy it is normal to have some light bleeding for a few days. Post-operative pain is normal and varies from woman to woman. Sometimes there is swelling and bruising around the vulva but this will all resolve over a few weeks. There is a small risk of infection and you should see your doctor if you notice offensive discharge or pus from the area or if you develop a fever as you may require antibiotics. The biggest risk is that the operation fails to improve your symptoms. Worst case scenario is that your pain is made worse by having the procedure although that is extremely unlikely.
Your doctor will review you four to six weeks after the operation. It is likely that some of the stitches will still be in place at that point and can be removed during your consultation. You will also be examined which gives an indication of how successful the operation is likely to have been and allows your doctor to plan further management.
