Vestibulectomy: Procedure, Indications, Recovery & Risks
Definition
A vestibulectomy is surgical excision of the vestibule (the posterior vaginal introitus, including the hymenal ring, Hart's line, and minor vestibular glands). It is not removal of the entire vagina.
Primary Indication
Provoked Vestibulodynia (Vulvar Vestibulitis Syndrome) – localized, severe pain at the vaginal entrance upon touch/penetration, unresponsive to conservative therapy (topical anesthetics, physical therapy, cognitive-behavioral therapy, hormonal management).
Other Indications
- Vaginal agenesis/hypoplasia (part of vaginoplasty)
- Vestibular malignancy (rare)
- Severe lichen sclerosus confined to vestibule
- Congenital anomalies (e.g., imperforate hymen variants)
Procedure Overview
- Anesthesia: General or regional.
- Excision: Circumferential removal of vestibular mucosa (typically 5–8 mm width) from Hart's line to hymenal remnants.
- Advancement: Vaginal mucosa mobilized and advanced to cover defect (perineoplasty often combined).
- Closure: Absorbable sutures.
Recovery & Outcomes
- Outpatient or 23-hour stay.
- Pain: Moderate (5–7 days); managed with NSAIDs, topical lidocaine, sitz baths.
- Dilator therapy: Often prescribed post-op to maintain patency.
- Success Rate: 60–80% significant pain reduction in vestibulodynia.
Risks
- Bleeding, infection, wound dehiscence
- Stenosis (narrowing) – prevented with dilators
- Sexual dysfunction (dyspareunia, reduced lubrication) – usually improves if pain resolves
- Altered vulvar anatomy/sensation
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