Simple posterior vestibuloplasty for central introital dyspareunia

The aim of this study is the evaluation of a simple surgical widening plasty of the posterior vestibulum for central introital dyspareunia. This study takes place in gynecological infectious diseases clinic in secondary and tertiary care centers. The subjects are one hundred forty-five consecutive patients with introital pain during or when attempting sexual intercourse. One-digit examination of the posterior hymenal rim of the vulva elicits the specific pain and clinical examination reveals nothing abnormal or only focal redness on the central posterior vestibulum. This condition should be clearly differentiated from the focal-provoked vestibulodynia, although mixed forms are frequent. A questionnaire was composed to assess the level of pain experienced during intercourse and of satisfaction of their sexual life in general at 1 to 3 years after the intervention. After a mean of 3 years, 90% of the patients were very satisfied with the improvement of the sexual health due to the intervention. Eighty percent had less pain during intercourse. The proportion of patients forced to interrupt sexual intercourse because of pain dropped from 64% to 26% (p < 0.0001). The number of women only having infrequent intercourse (once a month or less) decreased more than fourfold and the mean number of occasions that sexual intercourse took place increased by 27% after the intervention. Simple surgical widening plasty of the posterior vestibulum without excision of tissue led to a significant improvement of the sex life of at least 80% of a group of women with primary and secondary central introital dyspareunia of any cause. Correct and specific diagnosis is crucial prior to any intervention.