American Journal of Obstetrics and Gynecology
Surgeon's CornerSurgical management of neuroproliferative-associated vestibulodynia: a tutorial on vestibulectomy with vaginal advancement flap
Section snippets
Problem
Sexual dysfunction is a far-reaching problem impacting the lives of countless women and is often overlooked, misdiagnosed, and under-reported.1 Sexual pain is a nebulous term that can create unease for practicing clinicians lacking proper training to appropriately manage this clinical conundrum. In 2015 at a conference sponsored by 3 societies centered on female sexual health, new nomenclature was proposed referred to as the “2015 classification.”2 The proposed classification centered on 2
Our Solution
In this surgical video tutorial (Video 1), we highlight a surgical technique when performing a vestibulectomy with a vaginal advancement flap for refractory NAV. The video highlights key anatomical landmarks (Figure 1)6 that surgeons should understand before performing this procedure. We provide detailed instructions for identifying Hart’s line (Figure 2) as well as outline the course of dissection to safely perform this procedure (Figure 3). Our dissection technique stresses meticulous
References (6)
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Vulvodynia: definition, prevalence, impact, and pathophysiological factors
J Sex Med
(2016) Surgical techniques: surgery for vulvar vestibulitis syndrome
J Sex Med
(2006)- et al.
Facilitators and barriers in the diagnostic process of vulvovaginal complaints (vulvodynia) in general practice: a qualitative study
Eur J Gen Pract
(2018)
Cited by (6)
Inflammation, lipids, and pain in vulvar disease
2023, Pharmacology and TherapeuticsVaginal Microbiome Is Associated With Vulvodynia, Vulvar Pain Syndrome: A Case-Control Study
2021, Sexual MedicineCitation Excerpt :Some studies have proposed that vulvodynia is caused by genital infections, recurrent vulvovaginal candidiasis, herpes simplex virus, human papilloma virus (HPV), contact dermatitis, irritants, or vulvar trauma, but findings have been inconsistent.6 However, given that the presentations and responses to treatments are relatively diverse, some patients are responsive to medical treatments; however, some patients are refractory to the medical treatments and surgical treatment options including vestibulectomy should be considered;7 therefore, the optimal vulvodynia care requires a multimodal therapeutic approach8 and the cause of vulvodynia is most likely multifactorial including microbiota. Burton et al first reported the association between the vaginal ecosystem and infection in 2003.9
Innervation of the human vulvar vestibule: A comprehensive review
2023, Clinical AnatomySurgical treatment for provoked vulvodynia – Where do we stand? A narrative review
2021, PelviperineologyVulvar vestibulectomy
2020, Female Sexual Pain Disorders: Evaluation and Management
A.G. has received research funding from Ipsen, Endoceutics, SST, The Cellular Medicine Association, The Gynecologic Cancers Research Foundation, and Elen and is a consultant to Ipsen, SST, Amag, and Lupin. The other authors have nothing to disclose.
Cite this article as: Wu C, Goldstein A, Klebanoff JS, et al. Surgical management of neuroproliferative-associated vestibulodynia: a tutorial on vestibulectomy with vaginal advancement flap. Am J Obstet Gynecol 2019;221:525.e1-2.