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PROVOKED VESTIBULODYNIA

PROVOKED VESTIBULODYNIA



[ Tissue sample from a patient suffering from provoked vestibulodynia: After an abnormal increase, the nociceptors (shown in brown) start covering more than half of the epithelial cells. ]
Provoked vestibulodynia refers to severe pain such as burning or piercing sensation that is experienced when pressure or stimulation is applied in the space between the labia minora and the hymen, and it is characterized by dyspareunia (pain during intercourse). Women may experience dyspareunia during their first intercourse or all of a sudden after engaging in normal sexual activities. Provoked vestibulodynia isn’t a rare condition as it occurs in 12% of all adult women.

First, it may result from abnormal increase in the number of nociceptors that sense pain in the vestibular region as a result of an inflammation due to fungal infection and so on. Increased activity of the mast cells causes the number of a nerve growth factor called heparanase to grow, and causes the number of nociceptors on the mucosa of the vestibular region to increase by 10-fold, resulting in provoked vestibulodynia.

Second, it can be related to a genetic factor. In this case, it is a primary dyspareunia that is experienced starting from the first sexual intercourse.

Third, it may be due to hormonal changes. Dyspareunia may occur after prolonged administration of oral contraceptives (birth control pills), which leads to a reduction in the testosterone level and this in turn causes the testosterone receptors to cause damage to the epithelial cells in the vestibular region.

A wide variety of chemical allergens such as anti-fungal ointments, semen, underwear and sanitary napkins can also lead to provoked vestibulodynia.

A woman with provoked vestibulodynia experiences extreme pain when her vaginal opening is touched or pressed. Severe pain is caused by not only penile penetration by also insertion of a finger, a tampon or vaginal speculum for an OB/GYN exam. Depending on the degree of pain, some women can engage in sexual intercourse, withstanding the pain, but in severe cases, penetration is impossible. So, women suffering from provoked vestibulodynia may abstain from sex or fail to have a normal sexual relationship. In some cases, affected women may secondarily develop a penetration phobia due to pain, and for this reason, vaginismus, characterized by an involuntary tightness of the pelvic floor muscle, is also observed in more than 90% of the women with provoked vestibulodynia.

Treatment methods available for provoked vestibulodynia can largely be divided into non-surgical treatment and surgical treatment. In the past, the preferred methods were non-surgical such as topical remedy involving testosterone and local corticosteroids, interferon injections, local anesthetics, tricyclic antidepressants, antiepileptics and so on. However, these methods result in high recurrence rate and in most cases, the objective is to reduce the degree of pain to a bearable level and not to eliminate the pain completely.

With the effectiveness and safety of surgical methods reported in several research papers and reports by the International Society for Sexual Medicine, surgery has become the primary choice of treatment for provoked vestibulodynia on many occasions. At Yefine Women’s Clinic, vestibulectomy has been safely performed on countless patients with high success rate. It is also important to note that surgical treatment is the only method allowing complete elimination of pain during intercourse and preventing recurrence. There are no other clinics in Korea with more experience in vestibulectomy than Yefine Women’s Clinic. In addition, compared to the satisfaction rate of 60 to 70% for non-surgical treatments, over 90% of patients opting for vestibulectomy have reported that they no longer experience pain during intercourse and are satisfied with the result.



Characteristics of Yefine’sVestibulectomy


The objective is to completely eliminate dyspareunia, and not to partially improve the symptoms.
Provoked vestibulodynia that could not be treated with drug therapy can be successfully treated through vestibulectomy.
Patients experience minimal pain after surgery and do not have any trouble engaging in their day-to-day activities on the following day.
Compared to drug therapy, the treatment success rate is much higher (over 90%) and it does not cause recurrence.
There is no discomfort or pain caused by repeated injections.
It is safe to apply on non-married women. It leaves no external traces and does not affect the chances of pregnancy or childbirth afterwards. It also has little to no side effects.
The surgery lasts about an hour, and it is performed under low-level sedation induced by IV anesthesia and IOWA pudendal block, which are safer and less risky than sedative anesthesia. Also, patients can be discharged and drive or use public transportation on the day of the surgery, and experience fast recovery.
The treatment period is about 10 weeks, and the pelvic physical therapy is performed to treat the symptoms of vaginismus. Patients who cannot come to our clinic for the pelvic physical therapy are taught the post-surgery care methods that can be implemented at home.
Intense exercise should be avoided for 4 weeks after surgery. Showering is possible after surgery, but bathing should be avoided for 3 weeks after surgery.
Yefine Women’s Clinic has the most abundant experience in performing surgery to treat provoked vestibulodynia and boasts a high success rate.