Vaginal apex resection: a treatment option for vaginal apex pain

Vaginal apex pain is a subset of chronic pelvic pain commonly treated with surgical excision of the vaginal apex. Our objective was to estimate long-term postoperative pain levels, recovery time, and return to sexual function in women who have undergone vaginal apex repair for chronic vaginal apex pain.

Since 1995, 45 women have undergone vaginal apex repair at our institution. All were asked to complete a questionnaire describing pain levels, sexual function, daily activities, ability to work, and medical therapy before and after surgical repair of the vaginal apex. Demographic background, previous medical history, and surgical history were abstracted from the medical records. Fisher exact and Wilcoxon rank sum tests were used to determine associations among baseline characteristics and various outcomes. McNemar chi(2) testing was use to compare before and after pain levels.

Twenty-seven women constituted the study sample and were available for evaluation before and after vaginal apex repair. Sixty-seven percent of respondents experienced resolution of pelvic pain after vaginal apex repair for a median of 20 months. The number of women experiencing pain with daily activities decreased from 92% before vaginal apex repair to 41% after vaginal apex repair, and 30% reported sexual activity without dyspareunia after vaginal apex repair (P = .004). Sixty-one percent of women returned to work after vaginal apex repair. Most patients required continued medical therapy after vaginal apex repair.

Vaginal apex repair improves general levels of pelvic pain in some patients diagnosed with vaginal apex pain. Pain relief after vaginal apex repair is temporary, and women are likely to need continued medical therapy.