[Vulvoperineoplasty]

Vulvoperineoplasty is a surgical operation consisting of: (1) wide cleavage of the posterior vaginal wall, as in posterior colpoperineorrhaphy; (2) excision of a triangular segment of perineal skin, the summit of which touches the margin of the anus; (3) full exposure of the perineal central fibrous core and reduction of its relief by radial incisions and digital dissection; (4) lowering and eversion of a posterior vaginal flap with good blood supply in order to reconstruct the fourchette of the enlarged vaginal opening. This technique is applicable not only to congenital or acquired vulvar stenosis but also to the treatment of sclerous or dystrophic lesions of the fourchette. It was used on 43 occasions between 1978 and 1983, viz. in 6 patients after surgical treatment of prolapse, in 14 patients after obstetrical injury, in 17 cases of lichen sclerosus of the vulva and in 6 cases of Bowen's disease. The results were anatomically perfect in all cases, cosmetically good in 40 cases and functionally satisfactory in 40.