The role of vaginal apex excision in the management of persistent posthysterectomy dyspareunia

Objective: The purpose of this study was to evaluate the effectiveness of vaginal apex excision in the treatment of patients with posthysterectomy dyspareunia. Study Design: This was a case series with an independent third-party survey of patients with posthysterectomy dyspareunia managed at the University of Utah Pelvic Pain Clinic. Thirteen patients were first treated with local injections of anesthetics into localized vaginal pain foci. Further evaluation included formal psychometric testing and a diagnostic spinal block. Nine patients underwent surgical excision of the vaginal apex. An independent interviewer who did not know the patients assessed the effects of this procedure on dyspareunia and coital frequency at a mean of 36.4 ± 3.7 months after the operation. Results: The mean coital verbal analog pain score (1-10 scale) decreased from 9.22 ± 0.27 before excision of the vaginal apex to 3.11 ± 0.84 after the operation (P< .001), and coital frequency improved from 5.22 ± 2.02 episodes per month before surgery to 11.11 ± 1.82 episodes per month after surgery (P = .02). Of the 9 patients, 5 essentially had the dyspareunia cured. Dyspareunia was decreased and coital frequency was markedly increased in all but 1 of the other 4 cases. Conclusion: Excision of the vaginal apex is an effective treatment for carefully selected patients with posthysterectomy dyspareunia. (Am J Obstet Gynecol 2000;183:1385-9.)