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The Value of Histology in Predicting the Effectiveness of Vulvar Vestibulectomy in Provoked Vestibulodynia

Brokenshire, Christopher1; Pagano, Ross FRANZCOG2; Scurry, James FRCPA3

Journal of Lower Genital Tract Disease: April 2014 - Volume 18 - Issue 2 - p 109–114
doi: 10.1097/LGT.0b013e31829fae32
Original Articles

Objective: This study aimed to determine whether histology can predict response to vestibulectomy in the management of provoked vestibulodynia.

Materials and Methods: Inflammatory cell, mast cell, and nerve fiber counts were determined in prospectively collected vulvar vestibulectomy specimens from 30 women treated surgically for provoked vestibulodynia.

Results: Twenty-three subjects (77%) had a complete early response to surgery. At 3 years of follow-up, this had increased to 28 (93%), with a 29th showing some improvement. No subject had gotten worse after surgery or in the 3 years of follow-up. When comparing patients with an early complete response with those patients who still had symptoms, no difference in lymphocyte counts (27.6 vs. 37.8 per mm2), mast cell counts (110.4 vs. 97.8 per mm2), or stromal nerve fiber counts (16.4 vs. 16.4 per mm2) was found.

Conclusions: Vestibulectomy is a very effective treatment option in women with provoked vestibulodynia who have had failed conservative treatment. Histology is unable to predict which patients will respond to surgery.

Histology does not predict response to surgery in vulvodynia.

1Faculty of Health Sciences, University of Newcastle, Newcastle, New South Wales; 2Royal Women’s Hospital, Parkville, Victoria, Australia; and 3Anatomical Pathology, Hunter Area Pathology Service, Newcastle, New South Wales, Australia

Reprint requests to: James Scurry, Anatomical Pathology, HAPS, Locked Bag 1, HRMC, NSW 2310, Australia. E-mail jscurry@bigpond.com

The authors have declared they have no conflicts of interest.

Patients’ permission was obtained.

Copyright © 2014 by the American Society for Colposcopy and Cervical Pathology