Surgical treatment for provoked vulvodynia – Where do we stand? A narrative review

The treatment of vulvodynia remains challenging. Surgery (vestibulectomy) is an option for localized vulvodynia, but it is often considered only after failure of conservative approaches. The authors reviewed the available literature to establish the role, indications, complications, and success rates of surgical procedures. We conducted a literature search of all the papers published and indexed in PubMed since 2011 on the surgical treatment of vulvodynia. Women with localized provoked vulvodynia (LPV) form are the best candidates for the surgical treatment of vulvodynia. Success is associated with secondary LPV, improvement with lidocaine, premenopausal status, and intermittent rather than constant pain. While medical/ conservative treatment should generally be the first option, if a neuroproliferative etiology is suspected, surgery can be a first-line treatment. The available data do not allow us to draw conclusions about the best surgical technique. Efficacy (defined in different ways) is high (52%– 97%). The complication rate is low, cosmetic results are good, and vaginal delivery seems possible. Vestibulectomy is a safe and effective treatment for vulvodynia when delivered to appropriately selected women.