The Management of Vulvar Vestibulitis Syndrome with the Carbon Dioxide Laser

Vulvar vestibulitis syndrome produces vestibular pain and sexual dysfunction. It may be treated by excision of the hymen and vestibule, advancement of the vagina, and perineoplasty. In this study, the carbon dioxide laser was used to excise the affected tissue. The painful foci were excised in the midreticular dermis with a fine laser beam. The wound was either closed by advancement of the proximal vaginal tissues or left open to heal by secondary intent. No patient required hospitalization, and the procedure often was performed under local anesthesia. Neither serious intraoperative nor postoperative complications were encountered. Long-term complications included stenosis of Bartholin's ducts and residual focal erythema and pain. Histologic study of the excised tissue revealed nonspecific inflammation, vulvar intraepithelial neoplasia, human papilloma virus infection without dysplasia, and periadenitis of minor vestibular glands. Twenty (63%) of the 32 patients experienced pain relief and resumption of satisfactory coitus. (J GYNECOL SURG 5:87, 1989)