Vulvodynia is a medical condition that impacts the lives of many women but is however often underdiagnosed and mismanaged [1].  In 2015, the ISSVD (International Society for the Study of Vulvovaginal Disease) reformulated the definition of vulvodynia to ‘vulvar pain of at least three months’ duration, without clear identifiable cause, which may have potential associated factors’ [2]. Symptoms can be further categorized as localized, generalized (or mixed) and as provoked, spontaneous (or mixed). Provoked localized vulvodynia (PVD) or vestibulodynia is the most frequent cause of vulvar pain with an overall prevalence estimated at 8% to 15% [1,3,4,5]. The condition occurs in all ethnic groups and at any age with a peak incidence between the age of 20 to 29 years [5].  Non-invasive treatments include physiotherapy, psychological coaching or pharmacological treatments with use of neuromodulating agents such as anticonvulsants (e.g. gabapentin, both oral and topical) and antidepressants (e.g. notriptyline) [6]. Surgery is often considered for patients with PVD who are refractory to conservative management [7]. Surgical complications that have previously been reported include (wound) infection, wound dehiscence, hematoma, scarring or increased pain [8]. 

The objective of this study is to assess the effectiveness of vestibulectomy for vulvodynia through a prspective study. Randomisation is in this kind of interventional study not possible, however, after unseucesful local therapy, we will give patients two options (systemic medical therapy versus surgery) and will compare pre- and postoperative Nociceptive Rating Scale (NRS) scores at six different points around the vestibule with a Q-tip test as well as the patient satisfaction rates, the surgical complication rates and frequency of relapse.

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8. Goldstein AT, Pukall CF, Brown C, Bergeron S, Stein A, Kellogg-Spadt S. Vulvodynia: Assessment and Treatment. J Sex Med. 2016 Apr;13(4):572–90.