Vestibulectomy and Surgery of the Posterior Fourchette

So I saw my gynecologist today and she asked this surgeon (whose name I've heard quite a lot) to do an examination. He did the Q-tip test and said that I should have a vestibulectomy and also get the skin of my posterior fourchette cut, as I tear there and surgery is the only way to fix this and avoid the formation of scar tissue.

I've had provoked vestibulodynia/vulvodynia for about 2 years now. I've been on lyrica, amitriptyline cream and oral medication, had the laser treatment, and done physio. Nothing has worked, except for the amitriptyline cream at the very start but the pain came back and now it wont go away.

I was just wondering if anyone could please tell me about their experiences with surgery? I'm so nervous about doing it and am wondering if it's worth it. I'm worried I will regret it.

Thanks.

Hello, I am considering vestibulectomy as well but my doctor sees it as a last option. Now I'm on Lyrica and it's been 2 months. I haven't had any relief yet. How long have you used Lyrica?

Hi sgw11,

I had a full vestibulectomy a little over 4 years ago. I too have provoked vestibulodynia. For me, surgery was my last resort. I can see by what you've written that you're probably at your wits end of guessing game treatments. I had a very positive outcome from my vestibulectomy. After 6 months of healing I was finally able to have sex. It took some time and a lot of dilating, but I now have virtually pain free sex...and enjoyable sex. It took about a full year or so to get to the point of having pain free sex. The surgery is simple and only takes between 40 minutes to an hour. I didn't feel too much pain right after. The worst part of the process is the first two weeks of healing. You're pretty much bed ridden. You also have to tend to the area operated on, keeping yourself clean and comfortable. I took between 3 and 4 sitz baths a day to keep myself clean. They're pretty soothing.

Please let me know if you have any specific questions you need answered!

-Jen

Hello,

I just wanted to chime in about the symptom of tearing at the posterior fourchette, as this is something I experience too, any time I attempt sex. I also tear on either side just inside the opening, so where the Bartholin glands are.

Sgw11, you write that the only way to fix this is surgery.
When I first experienced Vestibulodynia (when I was on the pill), I also thought my recurrent tearing could only be fixed by something like surgery — because it would always happen no matter what I did to try and avoid it (using plenty of lubricant, taking things very slowly etc.). When the tearing became more frequent and worse over time, I could see what resembled a scar at the 6 o'clock area of the vestibule which was just re-opening. The skin felt permanently damaged and I could not envisage how it would ever be normal again.
However, due to my 100% recovery when I came off the pill (1.5 years of normal vestibule skin again), I know that it IS absolutely possible for the skin to heal entirely and stop tearing. I did not have any surgery. When my VV pain was gone, the skin returned to normal and so the tearing stopped entirely.
Now since VV is back after an infection, I have only attempted sex once and I tore in the same places. So now I know that tearing (for some of us) is a result of VV. If the aggravated nerves can be calmed down (for me simply coming off the pill cured this the first time), the tearing will stop too.
I don't personally believe surgery to remove the posterior fourchette alone will stop it from occuring in other places affected by VV pain, unless the ENTIRE area affected by VV is removed.
Just thought I'd contribute my experience/thoughts!

Thanks so much for replying guys.

Senozs1 - I was on lyrica for about 6 months but unfortunately for me there was no change of pain so I was taken off it.

Jen007 - sounds like the surgery went well for you! Congratulations. Thanks heaps, I'll send you a private message and ask you some more questions about the whole thing

A2015 - that's interesting. I've actually got a couple of appointments coming up next week so I'll ask them if being on the pill could contribute to the tearing. I'm also off the pill now and have experienced no relief from symptoms. I haven't always had tearing from vulvodynia, it has only really happened in the past year or so. My doctor thinks that the skin may be damaged from all the creams I was using simultaneously (amitriptyline, emuaid, and saginil), as my skin wasnt really getting a break, causing the tissue to appear waterlogged and tear easily. I have since been off these creams and I am still tearing.

What are you doing to treat your symptoms now?

Hi again sgw11,

Just to clarify, it's VV which is causing the tearing, not the pill alone, as I experience tearing now and I am not on the pill this time. When I had VV before, the pill had caused the entire VV condition! (so tearing included). Does that make sense?
You'll find several other women on these forums & elsewhere online that they suffer from tears. I believe that because VV makes the skin aggravated, it is just more fragile so susceptible to breaking. While I understand some topical treatments can irritate the area for some women, I firmly know from my own experience (our symptoms match entirely) that the tearing is simply a symptom of VV not any treatments applied to the area. When I first had VV for 18 months, I started to tear after around 10 months.

How long have you been off the pill now?

I'm currently using Lidocaine as much as I can for now, for minor temporary relief.

When you had relief using Ami cream, did you attempt sex during this time? And experience any tearing? Or did you feel significantly pain free enough to not worry about this happening during sex?

Hey A2015,

yep, when I was on the amitriptyline cream the symptoms went away and there was no tearing. We had pain free sex.

I had another meeting with one of my other gynaecologists yesterday, and he said there are plenty more paths for me to try before I should consider surgery. So I've upped my amitriptyline orals meds to max dose, and am using lidocaine mixed with a neutral base 5-6 times a day (studies have shown that doing this desensitises the nerves to pain, and eventually your brain stops associating touch or sex with pain, which stops the pain signals being sent), and am using oestrogen cream once before bed time on the areas which I tear. He wants me to do this for 1 month, then start on the dilators again, starting with the smallest. He also gave me some exercises to do because he says I now have secondary vaginismus, and showed me how to stop the muscles from spasming.

He wants me to try all this treatment for at least 4 months, and then if the pain is still there he said i could try gabapentin cream, and a different type of tricyclic for oral medication. He says my tissue looks healthy, and can barely see any scars from tearing (he looked with a magnifying thing), which is interesting because the gynaecologist the other day said she could see evidence of scarring. He said that he thinks that sometimes doctors look for what they want to see, but who knows.

So I'm gonna try this stuff first, obviously I will avoid surgery if I can.