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

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.