Bornstein et al identified clinical factors associated with poor outcome following surgery for vulvar vestibulitis. This can help identify women who may benefit more from nonsurgical modalities. The authors are from Carmel Medical Center and Technion-Israel Institute of Technology in Haifa, Israel.
Surgical procedure: vestibulectomy and vaginal advancement (perineoplasty)
Parameters associated with poor outcome after surgery in multiple logistic regression:
(1) constant vulvar pain of vestibular origin with dyspareunia
(2) presence of symptoms since first coitus
Parameter
Odds Ratio
95% CI
p value
constant pain
4.97
1.49 to 16.63
<= 0.004
since first coitus
5.83
1.74 to 19.55
<= 0.01
Possible algorithm (not given in reference)
Management
no risk factor
proceed with surgery
1 risk factor
try nonsurgical management first
both risk factors
nonsurgical management only
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