Introital primary and secondary dyspareunia: Multimodal clinical and surgical control

Doi : 10.1016/j.sexol.2011.10.001

B. Lambert ^a ^e ¹ , S. Bergeron ^b ² , M. Desrosiers ^c ³ , Y. Lepage ^d ⁴

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le mardi 27 décembre 2011

Summary

Background

The objective of this study was to evaluate the outcome of vestibulectomy on insertional dyspareunia, in a group of physical and sex therapy treated patients.

Methods

A group of vestibulectomized patients from January 2000 to February 2007 was reviewed in order to evaluate pre- and postoperative coital pain, possibility of vaginal intercourse and sexual satisfaction. Preoperative mean pain score was compared to postoperative, using a paired Student t test.

Results

Mean age was 23.0 years (18–38), mean preoperative pain score on a scale of 1–10 was 6.9±1.9 against 3.7±3.5 postoperative (P<0.001), and vaginal intercourse was possible in 36/40 (90%) of the evaluable total group of patients (n=61) and 31/40 who reached sexual satisfaction. However, in a subgroup of 25 patients, if secondary vestibulodynia (n=16) was markedly improved, with 7.2±1.3 as the mean preoperative pain rating against 2.9±3.1 postoperative (P<0.001), in primary cases (n=9), no significant vestibulectomy improvement was observed, with 6.6±2.6 against 5.2±3.4 postoperative (P=0.200).

Conclusions

Vestibulectomy following 10 weekly physical therapy sessions in addition to cognitive-behavioural sex therapy, appears to be a good surgical treatment of provoked vestibulodynia. Psychosexual and couple relational factors need advanced study for a minor group of resistant cases, especially in primary vestibulodynia where greater psychosexual counselling may be needed before attempting any surgical treatment.

Keywords : Vestibulectomy, Vestibulodynia, Insertional dyspareunia, Pain control