Surgical Management of Dyspareunia

NPWH/ISSWSH Women's Sexual Health Course for NPs (16-03)

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Irwin Goldstein, MD, IF

Objectives
• Describe diagnostic tests used to determine when a vestibulectomy is appropriate
• Classify the different kinds of surgical treatments of dyspareunia

Session Description
Approximately 30-40% of women will report bothersome sexual pain or dyspareunia during intercourse.
Sexual pain is best managed by a bio-musculoskeletal-psychosocial team approach in which a specific
diagnosis or hybrid multiple diagnoses are made after history, physical examination, laboratory testing
vulvoscopy, and other studies. There are multiple sexual pain syndromes, such as clitorodynia, urethral
meatal prolapse, neuro-proliferative vestibulodynia, recurrent fissure, or vulvar granuloma fissuratum and
Barthloin cysts that may need to be managed surgically. In particular, for women with neuro-proloferative
vestibulodynia, prior to consideration for complete vestibulectomy, a positive response to a vestibular
anesthesia test is required. Implantation of a pudendal neuromodulator may be considered for refractor
pudendal neuropathy.

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