Skip to main content
SpringerLink
Log in

Surgery for Vulvovaginal Pain Disorders and Dyspareunia

  • Chapter
  • First Online:
Urological and Gynaecological Chronic Pelvic Pain

  • 936 Accesses

Abstract

Vulvovaginal pain is often difficult to diagnose and treat. This chapter highlights a diagnostic algorithm that may aid health care providers in differentiating the cause of chronic vulvar pain caused by known etiologies such as lichen sclerosus or chronic candidiasis, and unknown causes such as vulvodynia. In the setting where pain persists despite conservative measures, refined surgical techniques may be indicated. Select populations that may favorably respond to surgical interventions include those suffering from pudendal neuralgia, vulvar vestibulitis/neuroproliferative vestibulodynia, lichen sclerosus, and hidradenitis suppurativa. This chapter will discuss relevant anatomy, conditions that might merit surgical intervention, and technical details of these procedures.

Pictures: Transgluteal positioning: http://wiki.med.uottawa.ca/pages/viewpage.action?pageId=22151800.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Alharbi Z, Kauczok J, Pallua N. A review of wide surgical excision of hidradenitis suppurativa. BMC Dermatol. 2012;12:9.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Amarenco G, Kerdraon J, et al. Efficacity and safety of different treatments of perineal neuralgia due to compression of the pudendal nerve within the ischio‐rectal fossa or by ischiatic spine. Rev Neurol. 1997;153:331–4.

    CAS  PubMed  Google Scholar 

  3. Ather S, Chan DS, Leaper DJ, Harding KG. Surgical treatment of hidradenitis suppurativa: case series and review of the literature. Int Wound J. 2006;3:159–69.

    Article  PubMed  Google Scholar 

  4. Bautrant E, de Bisschop E, Vaini-Elies V, et al. Modern algorithmfor treating pudendal neuralgia: 212 cases and 104 decompressions. J Gynecol Obstet Biol Reprod (Paris). 2003;32(Pt 1):705–12.

    CAS  Google Scholar 

  5. Barber MD, Bremer RE, Thor KB, Dolber PC, Kuel TJ, Coates KW. Innervation of the female levator ani muscles. Am J Obstet Gynecol. 2002;187:64–71.

    Article  PubMed  Google Scholar 

  6. Bergeron S, Binik YM, Khalife S, Pagidas K, Glazer HI, Meana M, et al. A randomized comparison of group cognitive – behavioral therapy, surface electromyographic Surgical treatment of vulvar vestibulitis. Pain. 2001;91:297–306.

    Article  CAS  PubMed  Google Scholar 

  7. Bergeron S, Khalife S, Glazer HI, Binik YM. Surgical and behavioral treatments for vestibulodynia: two-and-one-half year follow-up and predictors of outcome. Obstet Gynecol. 2008;111:159–66.

    Article  PubMed  Google Scholar 

  8. Blok JL, Spoo JR, Leeman FW, Jonkman MF, Horvath B. Skin-tissue-sparing excision with electrosurgical peeling (STEEP): a surgical treatment option for severe hidradenitis suppurativa Hurley stage II/III. J Eur Acad Dermatol Venerol. 2015;29(2):379–82.

    Article  CAS  Google Scholar 

  9. Blok JL, Boersma JB, Spoo JR, Leeman FJ, van den Heuvel ER, et al. Surgery under general anesthesia in severe hiradenitis suppurative: a study of 363 primary operations in 113 patients. J Eur Acad Dermatol Venerol. 2015;29(8):1590–7.

    Article  CAS  Google Scholar 

  10. Bonham A. CME review article: vulvar vestibulodynia: strategies to meet the challenge. Obstet Gynecol Surv. 2015;70(4):274–83.

    Article  PubMed  Google Scholar 

  11. Friedrich Jr EG. Vulvar vestibulitis syndrome. J Reprod Med. 1987;32(2):110–4.

    PubMed  Google Scholar 

  12. Goetsch MF. Simplified surgical revision of the vulvar vestibule for vulvar vestibulitis. Am J Obstet Gynecol. 1996;174:1701–5. discussion 1705–7.

    Article  CAS  PubMed  Google Scholar 

  13. Goldstein AT. Surgical techniques: surgery for vulvar vestibulitis syndrome. J Sex Med. 2006;3(3):559–62.

    Article  PubMed  Google Scholar 

  14. Goldstein AT, Klingman D, Christopher K, Johnson C, Marinoff SC. Outcome assessment of vulvar vestibulectomy with vaginal advancement for vulvar vestibulitis syndrome: results of a post-operative questionnaire survey. J Sex Med. 2006;3(5):923–31.

    Article  PubMed  Google Scholar 

  15. Goldstein AT, Burrows LJ. Surgical treatment of clitoral phimosis caused by lichen sclerosus. Am J Obstet Gynecol. 2007;196(2):126.e1–4.

    Article  Google Scholar 

  16. Goldstein AT, Burrows LH. Vulvodynia. J Sex Med. 2014;5(1):5–14.

    Article  Google Scholar 

  17. Golstein AT. Developing a new diagnostic algorithm for vulvodynia. Nat Vulvodyn Assoc. 2015;18(3):9 pages.

    Google Scholar 

  18. Harlow BL, Kunitz CG, Nguyen RH, Rydell SA, Turner RM, MacLehose RF. Prevalence of symptoms consistent with a diagnosis of vulvodynia: population-based estimates from 2 geographic regions. Am J Obstet Gynecol. 2014;210(1):40.

    Article  PubMed  Google Scholar 

  19. Hibner M, Desai N, Robertson LJ, Nour M. Pudendal neuralgia. J Minim Invasive Gynecol. 2010;17(2):148–53.

    Article  PubMed  Google Scholar 

  20. Juenemann KP, Lue TF, Schmidt RA, Tanagho EA. Clinical significance of sacral and pudendal nerve anatomy. J Urol. 1988;139:74–80.

    CAS  PubMed  Google Scholar 

  21. Peltier J. Anatomical basis of transgluteal approach for pudendal neuralgia and operative technique. Surg Radiol Anat. 2013;35(7):609–14.

    Article  PubMed  Google Scholar 

  22. Reed BD, Haefner HK, Sen A, et al. Vulvodynia incidence and remission rates among adult women: a 2 year follow-up study. Obstet Gynecol. 2008;112(pt1):231–7.

    Article  PubMed  Google Scholar 

  23. Robert R, Labat JJ, Riant T, et al. Neurosurgical treatment of perineal neuralgias. Adv Tech Stand Neurosurg. 2007;32:41–59.22.

    Article  CAS  PubMed  Google Scholar 

  24. Schlosser BJ, Mirowski GW. Lichen sclerosis and lichen planus in women and girls. Clin Obstet Gynecol. 2015;58(1):125–42.

    Article  PubMed  Google Scholar 

  25. Shafik A. Pudendal canal syndrome. Description of a new syndrome and its treatment. Report of 7 cases. Coloproctology. 1991;13:102–10.

    Google Scholar 

  26. Shafik A, el-Sherif M, Youssef A, Olfat ES. Surgical anatomy of the pudendal nerve and its clinical implications. Clin Anat. 1995;8:110–5.

    Article  CAS  PubMed  Google Scholar 

  27. Silbert PL, Dunne JW, Edis RH, Stewart‐Wynne EG. Bicycling‐induced pudendal nerve pressure neuropathy. Clin Exp Neurol. 1991;28:191.

    CAS  PubMed  Google Scholar 

  28. Swanson CL, Rueter JA, Olson JE, et al. Localized provoked vestibulodynia: outcomes after modified vestibulectomy. J Reprod Med. 2014;59(3–4):121–6.

    PubMed  Google Scholar 

  29. Tommola P, Unkila-Kallio L, Paavonen J. Surgical treatment of vular vestibulitis: a review. CTA Obstet Gynecol Scand. 2010;89(11):1385–95.

    Article  Google Scholar 

  30. Van Lankveld JJDM, Granot M, Schultz WCMW, Binik YM, Wesselmann U, Pukall CF, Bohm-Starke N, Achtrari C. Women's sexual pain disorders. Clin J Sex Med. 2010;7(1):615–31.

    Article  Google Scholar 

  31. Van der Zee HH, Prens EP, Boer J. Deroofing: a tissue-saving surgical technique for the treatment of mild to moderate hidradenitis suppurativa lesions. J Am Acad Dermatol. 2010;63:475–80.

    Article  PubMed  Google Scholar 

  32. Woodruff JD, Genadry R, Poliakoff S. Treatment of dyspareunia and vaginal outlet distortion by perineoplasty. Obstet Gynecol. 1981;57(6):750–4.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Obstetric & Gynecology, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA

    Traci Ito M.D., Gaby Moawad M.D. & Andrew Goldstein M.D.

  2. The Center for Vulvovaginal Disorders, Washington, DC, USA

    Andrew Goldstein M.D.

Authors
  1. Traci Ito M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gaby Moawad M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Andrew Goldstein M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. The Arthur Smith Institute for Urology, Hofstra Northwell School of Medicine, Northwell Health, Lake Success, New York, USA

    Robert M. Moldwin

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing AG

About this chapter

Cite this chapter

Ito, T., Moawad, G., Goldstein, A. (2017). Surgery for Vulvovaginal Pain Disorders and Dyspareunia. In: Moldwin, R. (eds) Urological and Gynaecological Chronic Pelvic Pain. Springer, Cham. https://doi.org/10.1007/978-3-319-48464-8_26

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-48464-8_26

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-48462-4

  • Online ISBN: 978-3-319-48464-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation