Surgical Treatment for Provoked Vulvodynia: A Systematic Review.

Objective: Provoked vulvodynia (PV), characterized by vulvar pain upon touch or pressure, is the leading cause of pain during sexual intercourse. It causes a significant decline in overall quality of life, including sexual dysfunction and mental distress. Surgical interventions, such as perineoplasty and vestibulectomy, are considered a last resort for PV cases unresponsive to less invasive therapies. This systematic review evaluates the efficacy of surgery for PV and suggests areas for future research.

Materials and methods: The literature search encompassed PubMed, Scopus, Web of Science, and Cochrane Library, identifying relevant peer-reviewed studies up to August 21, 2023.

Results: Out of 1102 records retrieved, 29 met the eligibility criteria. Surgery was typically considered after failed conservative treatments. In 15 of the 29 studies defining surgical success as a significant reduction in dyspareunia, success rates ranged from 52% to 93%. Six studies using validated scales for pain assessment noted a significant reduction in vulvar pain following surgery (p < .001). Two studies reported enhancements in sexual function ranging from 57% to 87%, while 3 studies found 89%-97% of women regained the ability to engage in sexual intercourse after surgery. Patient satisfaction rates ranged from 79% to 93%. Bartholin cysts occurred in up to 9% of cases, the most common complication reported.

Conclusion: Surgery seems to be an effective and safe PV treatment option with success rates ranging from 52% to 97%, depending on the variation of outcome measures. Randomized clinical trials with established outcome measures are needed to determine the best surgical approach with minimal operative risk and optimal long-term outcomes.