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



Odds Ratio

95% CI

p value

constant pain


1.49 to 16.63

<= 0.004

since first coitus


1.74 to 19.55

<= 0.01



Possible algorithm (not given in reference)


no risk factor

proceed with surgery

1 risk factor

try nonsurgical management first

both risk factors

nonsurgical management only


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