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Vestibulectomy has been the most investigated treatment for vulvar vestibulitis to date with over 20 published outcome studies, yielding success rates ranging from 43% to 100%. This minor surgical procedure, preformed as day surgery under general anesthesia, consists of the excision of the hymen and sensitive areas of the vestibule to a depth of about 2 mm, with some procedures involving the mobilization of the vaginal mucosa to cover the excised area. Following this procedure, women are generally instructed to abstain from all forms of vaginal penetration for 6–8 weeks. Our research group conducted a randomized treatment outcome study of vulvar vestibulitis comparing vestibulectomy, group cognitive-behavior therapy, and pelvic floor biofeedback. At posttreatment and 6-month follow-up, there was significant pain reduction for all three treatment groups. However, vestibulectomy resulted in approximately twice the pain reduction (47–70% depending on the pain measure) of the two other treatments (19–38%); it was characterized by a high success rate and by elevated percentages of pain reduction. In addition, there were significant improvements in overall sexual functioning and self-reported frequency of intercourse at the 6-month follow-up, with no treatment differences. However, means for intercourse frequency for all three groups remained below the mean frequency of intercourse for healthy women of similar age. In a 2.5-year follow-up of this study, members of all three treatment groups continued to improve over time. Vestibulectomy remained superior to the other two treatments with respect to pain ratings on the cotton-swab test, whereas women in the group therapy condition reported equal improvements in terms of self-report measures of painful intercourse. Changes in overall sexual functioning and intercourse frequency were maintained, with no group differences. These results suggest that although the benefits of group therapy may take longer to appear, it can be just as effective as surgery in reducing the pain experienced during intercourse. Alternative Treatments Alternative treatments for vulvar vestibulitis syndrome include acupuncture and hypnotherapy. Although few studies currently exist, there are promising data regarding the effect of acupuncture on pain reduction and overall quality of life. In addition, a recently published case study indicated that hypnosis reduced pain and helped re-establish sexual pleasure. Randomized controlled trials are needed in order to truly establish the effectiveness of these treatments. Alternative treatments seem promising, yet to date, only cognitivebehavioral therapy, biofeedback, and vestibulectomy have been empirically validated. It is also likely that concurrent treatment with multiple non-invasive methods may be even superior to single treatments, though this has yet to be investigated.
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About The Author David Crawford is the CEO and owner of a Top Male Enhancement company known as Male Enhancement Group which is dedicated to researching and comparing male enhancement products in order to determine which male enhancement product is safer and more effective than other products on the market. Copyright 2010 David Crawford of Best Male Enhancement This article may be freely distributed if this resource box stays attached.
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