Vestibulectomy

What is a vestibulectomy?

A vestibulectomy is a procedure to treat chronic pain in your vulva. Most often, the procedure treats pain at the vestibule of your vulva, which is the area near your vaginal opening. This condition is known as vestibulodynia. It’s not a treatment for all types of vulvar pain.

The surgery involves removing painful tissue in and around the opening of your vagina. The amount of tissue your surgeon removes depends on the severity of your symptoms and the location of the pain.

Healthcare providers usually recommend trying noninvasive treatments like oral and topical medication before recommending a vestibulectomy.

What are the types of vestibulectomy?

There are two types of vestibulectomy: partial and complete.

1. A partial vestibulectomy removes tissue in just the area causing pain. For example, it may involve removing tissue from just one side of your vaginal opening.
2. A complete vestibulectomy removes tissue from the entire vestibule of your vulva.

What does a vestibulectomy treat?

A vestibulectomy is a treatment for certain types of vestibulodynia (also called vulvar vestibulitis), which is pain that causes burning, stinging and soreness near your vaginal opening.

People with vestibulodynia may feel pain during sexual intercourse or when inserting a tampon or wearing tight clothing that rubs against the area.

How should I prepare for a vestibulectomy?

Your healthcare provider will let you know how you should prepare for the procedure, including when you should stop eating or drinking before the surgery. This depends on the type of anesthesia they use for the vestibulectomy. They’ll go over any other restrictions or precautions you should take in the days leading up to surgery, like if you should stop taking certain medications.

Other things that can happen before surgery include:

• Discussing your medical history, allergies and current medications in a pre-operative visit. You should use this opportunity to discuss any questions you have about the surgery and recovery.
• Having a physical exam or other tests to make sure you’re healthy for surgery. Tests could include a complete blood count (CBC) or pregnancy test.

The surgery takes place in a surgical center or hospital in most cases. It’s an outpatient procedure, meaning you don’t need to spend the night at the hospital.

What kind of anesthesia is used for a vestibulectomy?

Anesthesia for a vestibulectomy depends on factors like personal preferences and the extent of the surgery. Your provider can discuss the pros and cons of each type of anesthesia and recommend the best one based on your health history and your unique case.

You may be comfortable just having local anesthesia, which involves numbing just your vulvar area. This might offer enough pain relief when your surgeon is removing a small amount of tissue. Other times, your provider may recommend general anesthesia, meaning you’re asleep for the surgery. Some people choose a regional anesthetic. This type of anesthesia numbs you from the waist down, but you remain awake.

What happens during a vestibulectomy?

Generally, a vestibulectomy involves the following steps:

1. You receive anesthesia so you don’t feel pain during the surgery.
2. Your surgeon makes an incision (cut) on either side (or both sides) of your vaginal opening and removes the painful tissue.
3. They close the incisions with dissolvable stitches.

How long does a vestibulectomy take?

The procedure is an outpatient procedure, which means you go home the same day you have surgery. The procedure itself lasts 30 to 60 minutes, but this can vary depending on how much tissue your surgeon needs to remove.

What happens after a vestibulectomy?

After the procedure, you’ll recover in a special area until you feel well enough to go home. Even if you have local anesthesia, you may need someone to drive you home.

Your vulvar area will be sore and swollen for several days or weeks. Having ice packs and pain relievers on hand can help with discomfort. Be sure to discuss options for pain relief with your provider before leaving the surgical center. 

Your surgeon will give you instructions to follow during your recovery. It will include information on:

• Taking care of your incision or the surgical area.
• Bathing, showering, swimming and other rules for activities involving water.
• When you can have sex or use tampons. You may need to wait several weeks before you can insert anything into your vagina.
• Any follow-up appointments. You’ll likely have a post-operative appointment within four weeks of surgery.

What are the benefits of a vestibulectomy?

The main benefit of the procedure is pain relief. Activities that typically cause pain like sex or wearing a tampon can become less painful or not cause pain at all after a vestibulectomy.

Other benefits include:

• Improved sexual satisfaction due to not feeling pain with penetration.
• Better emotional well-being because you aren’t experiencing chronic pain.
• Improved confidence and self-esteem.

How successful is a vestibulectomy?

Most people find that this procedure relieves their pain. Up to about 3 in 4 people report significant pain relief. It’s a safe and effective procedure to treat painful tissue at your vaginal opening.

What are the risks or complications of a vestibulectomy?

The most common complications of a vestibulectomy are bleeding and infection. Other risks are:

• Still feeling pain after surgery.
• You still feel pain when inserting an object into your vagina.
• Changes in sensation or how your vagina feels. Some people report a decrease in lubrication, for example.
• Being unhappy with the cosmetic results (how your vagina looks).

What is the recovery time for a vestibulectomy?

Recovery after a vestibulectomy can last up to 12 weeks depending on how much tissue your healthcare provider removes. Some people recover in as little as six weeks. The exact time varies, so you should ask your healthcare provider what you can expect based on your situation.

When should I call my healthcare provider?

Contact a healthcare provider if you feel pain in your vulvar area, especially if it’s interrupting your daily activities or affecting your quality of life. They’ll perform a comprehensive exam and evaluation to determine the cause of your pain. Then, they can recommend the appropriate treatment based on your symptoms and the cause of the pain. In some cases, they may recommend a vestibulectomy to relieve the pain you feel at your vaginal opening.

How much does a vestibulectomy cost?

The cost for a vestibulectomy varies depending on factors like insurance coverage, your healthcare provider and where you live. You should contact your provider and insurance carrier to get an idea of what the procedure will cost.