title: Long-term well-being after surgical or conservative treatment of severe vulvar vestibulitis.
abstract: OBJECTIVE
  To compare long-term well-being of women who needed surgery or did not need surgery in the treatment of severe vulvar vestibulitis syndrome. We also attempted to identify factors explaining differences in the treatment response.
  
  
  METHODS
  An observational case-control study.
  
  
  METHODS
  University Hospital Vulva clinic.
  
  
  METHODS
  Sixty-six women diagnosed with severe vulvar vestibulitis and treated initially by conservative management during 1994-2005. Thirty-nine women did not respond and underwent posterior vestibulectomy and 27 were managed without surgery.
  
  
  METHODS
  Baseline patient characteristics, degree of dyspareunia, and details of management were collected from hospital charts. At the follow-up visit current dyspareunia, sexual well-being, somatic and mental health, and social support were analyzed. Vestibular tenderness was measured by swab-touch test.
  
  
  METHODS
  Visual analogue scale for dyspareunia, sexual well-being, vestibular tenderness, and overall patient satisfaction at follow-up.
  
  
  RESULTS
  Dyspareunia decreased significantly in both groups. The visual analogue scale decreased 66.7% in the surgery group and 78.1% in the conservative treatment group (p= 0.407). Posterior swab-touch test was negative more frequently after vestibulectomy. Long-term sexual well-being did not differ between the two groups. Overall, 89% of the women in both groups were satisfied with the treatment. Women with atopic skin problems were less likely to need surgery (odds ratio 0.2; 95% confidence interval 0.1-0.7).
  
  
  CONCLUSIONS
  Women with severe vulvar vestibulitis syndrome who do not respond to conservative management achieve good long-term well-being and decrease of dyspareunia by posterior vestibulectomy. The response is comparable to that achieved by conservative management among women who do not need surgery.
authors.affiliation: Department of Obstetrics and Gynecology, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland. paivi.tommola@kolumbus.fi
authors.forename: Päivi
authors.initials: P
authors.lastname: Tommola
authors.forename: Leila
authors.initials: L
authors.lastname: Unkila-Kallio
authors.forename: Jorma
authors.initials: J
authors.lastname: Paavonen
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D004414:Dyspareunia / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008499:Medical Records; D008875:Middle Aged; D010146:Pain / Q000209:etiology; D010147:Pain Measurement; D018579:Patient Selection; D010549:Personal Satisfaction; D012189:Retrospective Studies; D018401:Sample Size; D012720:Severity of Illness Index; D012725:Sexual Behavior; D014110:Touch; D016896:Treatment Outcome; D054515:Vulvar Vestibulitis / Q000150:complications* / Q000523:psychology / Q000601:surgery / Q000628:therapy*; D055815:Young Adult