Long-term outcome of perineoplasty for vulvar vestibulitis

Our objective was to ascertain the long-term outcome of perineoplasty in the treatment of vulvar vestibulitis and to search for variables associated with a successful outcome. Treatment success and failure were compared across subgroups defined by age, parity, duration of symptoms, type of pathology, degree of partner support, psychiatric history, sexual abuse history, and the patient's opinion of the postoperative appearance. This was a hospital-based study of 93 patients undergoing perineoplasty for vulvar vestibulitis. We report on long-term (greater than 48 months) postoperative outcome and compare successful and failed cases over selected patient variables. Overall outcome was found to be 51 of 93 (54.8%) 'asymptomatic', 31 of 93 (33.3%) 'minimally symptomatic', 7 of 93 (7.5%) 'unchanged', and 4 of 93 (4.3%) 'worse' symptoms. Differences in surgical success across subgroups for age, parity, duration of symptoms, type of pathology, degree of partner support, psychiatric history, sexual abuse history, and the patient's opinion of the postoperative appearance did not achieve statistical significance. Other than the percentage of patients who failed to have improvement of pain, 11 of 93 (11.8%), the major postoperative complication rate was low, with 1 of 93 (1.1%) patients reporting anal sphincter weakness. No variables studied predicted surgical success in correcting vulvar vestibulitis. Given the low long-term failure rate and complication rate, perineoplasty should remain an appropriate therapeutic choice for vulvar vestibulitis following the failure of less invasive treatments.