Introital primary and secondary dyspareunia: Multimodal clinical and surgical control

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. 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. 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). 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.