VVS Surgery email part 2

Copy of second part of email from Vulvar Vestibulitis Relief


Sugery for VVS: Part II


The time has come for part II of the emails on surgery! I've gotten some interesting questions on this topic so what I'd like to do is to compile all of the questions I've gotten about surgery at the end and either send out a follow up email or include them at the end of each article once they are up on the website. In any case, please keep the questions and/or thoughts on surgery coming! And without any further chitchat, here's part II:

Why Do Some Women Still Have Pain After Surgery?

The most common reason cited for the continuation of pain post surgery is that the patients also have “pelivc floor dysfunction”. Another contributing factor can be the presence of infections but this topic will be covered in the next email.

(Side note: I have often wondered why these women who have pelvic floor dysfunction are able to get the surgery done since removal of the tissues will have no effect on the muscular function. The reason that most makes sense to me is that those women elect to have the surgery to remove all the vestibular problems and to deal with the pelvic floor dysfunction later. This makes sense only for women who fully understand what outcomes to expect.)

Why exactly is the pain still there?

So while the vestibular tissue no longer has any inflammtion and/or source of pain (whether it be from hormone definiciency, skin fissures, nerve pain, etc.) the muscles in the vulvar area and surrounding pelvic area may still not be functioning normally. From personal experience, this most often causes a burning sensation (especially during uration or during/after any attempts at penetration).

Luckily, pelvic floor dysfunction is understood a great deal more than vulvar/gland pain (ok, so that’s not saying much but at least it is more). As a result, muscular problems can be vastly improved over time. And while I’m not saying that this problem can be easily “cured”, it can be controlled. Unfortunately, it does take quite a bit of time and effort to retrain muscles once they’ve been set in their malfunctioning ways. Therefore, physical therapy plays an important role for these patients.

(I have written quite a few previous articles about physical therapy and ways to deal with muscular dysfunction so it might be of interest for you to browse the articles page of the website.)

In reality though, physical therapy plays an important role for all women who elect to have surgery for VVS because of it’s role in postoperative rehabilitation.

But let me back up for a second; there are actually several important steps for post operative care which include the following:

1) Liberal and immediate use of ice packs in the days following surgery.
2) Sitz baths several days after surgery and continuing into the subsequent weeks afterward.
3) Limited physical activity for 6-8 weeks (or more, in some cases) after surgery.
4) And of course, physical therapy.

Because the vaginal skin/tissues are made to expand and contract, women who have surgery most often have to work to get the remaining skin to make up for the tissue that was excised. So when it comes to physical therapy, several techniques are used:

1) Dilator work--this functions to retrain the tissue (which has, in most cases, been advanced) to stretch during sexual activities.

2) Biofeedback--this trains the muscles to respond normally (note that the muscles can often react to the surgery, even if no pelvic floor dysfunction is present prior to surgery).

3) Manual and trigger point therapy--this is for many of the same long-term reasons as above. Another positive to trigger point therapy is that it can have short-term benefits by causing the muscles to relax when pressure is applied. This commonly results in an immediate reduction in pain levels.

So having covered physical therapy, I'd like to get to some more commonly asked questions:

What’s the Average Recovery Time?

The average recovery time is about 2 months although that tends to be on the more optimistic side; many women return to normal functioning closer to 3 months and physical therapy can last even longer (this, obviously, is really variable based on a woman's past history). This is also very dependent on how closely a woman sticks to the regiment that her health care team outlines. Some things that women commonly do that prolong their recovery time is participating in vigorous physical activities too early on and not doing their physical therapy exercises outside of their PTs office.

Glands are often removed during surgery; how doees this affect lubrication?

Most doctors say that vulvar vestibulectomies result in about 25% less of vaginal lubrication due to the fact that glands are removed (most often, it is the Bartholin glands). Therefore, how much this affects lubrication depends on the amount of lubrication each women had prior to surgery. Some women need to use a lubricant after the surgery while some return to completely normal functioning (as in, no need for lubricant). In any case, most surgeries performed nowadays don't involve the removal of all of the glands in the vestibule.

That's it for Part II on surgery! Part III will be out shortly and will cover topics such as the role of infections on postoperative pain (including how well women with infections are suited for surgery) and how to approach talking to your doctor about surgery. As always, questions, comments, concerns are welcome!

Wishing you pain-free days