(037) Assessment of Vulvar Appearance and Genital Self-Image Following Complete Vestibulectomy

Abstract Introduction Patients considering complete vestibulectomy with vaginal advancement flap reconstruction for neuroproliferative vestibulodynia (NPV) have expressed concerns regarding post-operative appearance of their genitalia. Objective This study collected data by assessing changes in genital appearance and genital self-image in NPV patients after complete vestibulectomy in order to more accurately provide preoperative counseling for future vestibulectomy patients. Methods Charts of patients who underwent complete vestibulectomy between 6/2020-1/2025 and vulvoscopy with photography at least 3 months postop were reviewed. Data collected included patient-reported outcome measures and vulvoscopic assessment. The Vulvar Genital Tissue Appearance scale, developed for menopause treatment outcome studies, was modified for this study (mVGTA). Deidentified pre- and post-operative vulvoscopic photographs were graded for appearance 0 (none) to 3 (severe) by a neutral reader (Fig. 1). After unblinding, mVGTA data were analyzed using descriptive statistics and Wilcoxon matched-pairs signed rank tests. In addition, the vaginal advancement flap was examined for color and scar tissue. To assess self-image following vestibulectomy, patients were administered the Female Genital Self-Image Scale (FGSIS), which was analyzed using on-parametric Spearman’s correlation and Spearman’s r. FGSIS free text responses were codified by themes and statement count for each theme and presented visually. Results 53 patients, mean age 27.7 (SD 7.9) met inclusion criteria, with average age of symptom onset 14.5 years (SD 9.9). The average time from surgery to post-operative vulvoscopy was 9 months (range 3 mo - 54.1 mo). Surgical pathology revealed CD117 density to be .72 (% cross-sectional area) and PGP 9.5 .47%. According to the Patient Global Impression Index-Improvement (PGI-I) 86.8% of patients reported feeling “better” after surgery. There were statistically significant reductions in introital pallor (p = 0.01), introital erythema (p = 0.0005), fissure (p = 0.0093), posterior tightness (p = 0.0028) and total mVGTA score (p 0.0001) suggestive of improved tissue appearance (Fig. 2). The vaginal advancement flap was pink in color, with no scar tissue between the vagina and vulva in all patients. Additionally, there was no statistically significant correlation (Spearman r = -0.227) between FGSIS and post-vestibulectomy mVGTA composite score (p = 0.25). Qualitatively, there were 16 statements discussing function and 9 discussing appearance (Fig. 3). Conclusions These novel mixed-methods findings show that after complete vestibulectomy with vaginal advancement flap there is objective improvement of genital appearance in multiple parameters. Qualitatively, when discussing self-image, function matters more to these patients than appearance. The surgeon may use these data to understand patient goals and reassure patients concerned about function and cosmesis following vestibulectomy. Disclosure No.