Focal vulvitis: a psychosexual problem for which surgery is not the answer

Area of Science:

• Gynecology
• Dermatology
• Sexology

Background:

• Focal vulvitis, a syndrome of burning vulvar pain and superficial dyspareunia, has emerged in the last decade.
• Woodruff perineoplasty has been a recommended surgical treatment for focal vulvitis.

Purpose of the Study:

• To investigate the long-term efficacy of Woodruff perineoplasty for focal vulvitis.
• To explore the underlying causes and contributing factors of focal vulvitis.

Main Methods:

• Retrospective analysis of patients undergoing Woodruff perineoplasty.
• Evaluation of surgical outcomes and patient-reported symptoms.
• Assessment of etiological factors including mechanical, chemical, and psychosexual elements.

Main Results:

• The majority of women experienced persistent focal vulvitis symptoms post-surgery, indicating treatment failure.
• Identified immediate causes included mechanical and chemical vulvar irritation.
• Inadequate sexual behavior, such as insufficient lubrication and pelvic floor hypertonia, was prevalent.
• Psychosexual factors, including decreased libido and depression, significantly contributed to the condition.

Conclusions:

• Woodruff perineoplasty should be abandoned as a treatment for focal vulvitis due to its ineffectiveness.
• An integrated treatment approach is recommended, encompassing vulvar skin care, pelvic muscle relaxation, and sexological therapy.