ABSTRACT

Since the 1980s, a flood of women have presented with introital dyspareunia and chronic unexplained vulvar discomfort, for which no clear-cut somatic diagnosis can be found. Three decades of research has failed to attribute this syndrome to a structural disease process. Pathogenesis reflects an interaction between individual hypersensitivity and an external irritant, creating a self-sustaining pain reflex. This reflex has well defined afferent (sensory), central (dorsal horn) and efferent (motor) arms. As such, vulvodynia fits the model of a complex regional pain syndrome. Most women respond to conservative treatment, involving membrane stabilizing drugs (to downregulate pain transmission through the dorsal horn) and a biofeedback-controlled exercise program (to stabilize electrical transmission within the efferent arm the spinal pain reflex). In refractory cases, there is sometimes a need to excise the tissue from which the most intense pain signals are arising. This has been most commonly done by vestibulectomy. This article describes a microsurgical technique for Bartholin’s glands excision, as a less ‘anatomy-altering’ and more effective alternative. During calendar years 1999-2014, 99 patients were adjudged suitable for microsurgical removal of the Bartholin’s glands. Of these 99 women, pain free intercourse was re-established in 93 (94%) patients, and another two (2%) had partial improvements. There was a 4% failure rate (four women). No major complications were encountered.