Ip28-09 Objective Assessment of Vulvar Tissue Changes and Patient-reported Genital Self-image Following Complete Vestibulectomy
Year: 2026
Type: article
Study design: Observational Study
Abstract: INTRODUCTION AND OBJECTIVES: Patients with neuroproliferative vestibulodynia considering complete vestibulectomy with vaginal advancement flap reconstruction have expressed concerns regarding post-operative genital appearance.This study aims to assess post-operative changes in genital appearance and genital self-image.METHODS: Charts of patients who underwent complete vestibulectomy 6/2020 to 1/2025 were reviewed for Patient Global Impression of Improvement (PGI-I) scores and vulvoscopic photographs, assessed using a modified Vulvar Genital Tissue Appearance scale (mVGTA).Deidentified pre-and post-operative photographs were graded 0 (none) to 3 (severe) by a blinded reviewer.Data were analyzed using descriptive statistics and Wilcoxon matched-pairs signed rank tests.To assess self-image following vestibulectomy, patients completed the Female Genital Self-Image Scale (FGSIS), which was analyzed using on-parametric Spearman's correlation and Spearman's r.FGSIS free text responses were codified by themes and statement count and examples presented visually.RESULTS: 53 patients, mean age 27.7 (SD 7.9), met inclusion, with average age of symptom onset 14.5 years (SD 9.9).Average time from surgery to post-operative vulvoscopy was 9 months (range 3 -54.1).86.8% of patients reported feeling 'better' after surgery based on PGI-I.There were statistically significant reductions in introital pallor (p[0.01),introital erythema (p[0.0005),fissure (p [ 0.0093), posterior tightness (p[0.0028) and total mVGTA score (p<0.0001)suggestive of improved tissue appearance.The vaginal advancement flap was pink in color, with no scar tissue between vagina and vulva in all patients.There was no statistically significant correlation between post-op mVGTA composite score and FGSIS.Functionrelated responses included overall satisfaction with surgical outcome (5), persistent pain or sexual dysfunction (7), function as more important than appearance (3) and hope that function will continue to improve (1).Appearance-related themes included positive self-image (4), self-empowerment (1), negative post-operative changes (2), and negative self-image (2).Three statements demonstrated psychosocial confounders such as low desire, fear of intimacy, and relationship problems.CONCLUSIONS: These mixed-methods findings show objective improvement of genital appearance after complete vestibulectomy with vaginal advancement flap.Qualitatively, function matters more to these patients than appearance.These data may help the surgeon better understand patient goals and reassure them regarding cosmesis following vestibulectomy.
Source: The Journal of Urology
Language: English
Subfield: Psychiatry and Mental health
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W7155865583