Transcript of VPS Podcast 10 - First hand account - Having a vestibulectomy: a presentation given by Alexandra Black

This is a transcript of the soundtrack from VPS Podcast 10, which is a slide presentation given by Alexandra Black at the VPS Super Workshop on 9 May 2015. You can view the slides accompanying the soundtrack on the VPS website at Podcast 10 - First hand account - Having a vestibulectomy: a presentation given by Alexandra Black. Timings of each slide are provided in order to aid quick location.

 

Slide 1 (00:00)    Having a vestibulectomy

My name’s Alex. I’m a patient who’s had provoked vestibulodynia. I’m also a final year medical student at Birmingham. I’ve just finished my finals and hoping to go into Obs & Gynae [Obstetrics and Gynaecology] one day. We’ll see how that goes.

The reason I’ve come to talk today is just about what it’s like to actually have the procedure and have recovery afterwards and things. I’m happy to answer any questions and I’m pretty unembarrassable, I think, so go for it!

Slide 2 (00:25)    What happens during a vestibulectomy

Just briefly, in case anyone’s a bit unsure what the procedure is, it’s where the back wall of the vagina, which is where you get pain in this condition, is removed. I think it’s usually done under general anaesthetic, which is what I had. It may be able to be done under sort of more local. [She indicates Slide 2, which shows four diagrams detailing a vestibulectomy procedure.] That’s just a diagram to show you roughly what the procedure is.

Slide 3 (00:49)    Timeline of treatment

Like most people here, I imagine, I had quite a long journey before I got some treatment. My symptoms began in 2008, when I had thrush, and then I went to see a GP about everything early in 2009. I was getting a burning pain at the entrance of the vagina every time I tried to have sex or use a tampon. I’d also get bleeding as well – I know that’s not a typical symptom, but it’s something that affected me. They noted on one of my appointments that I had an erosion of the cervix, which is basically just a skin change, and that can cause your discharge to also change and make you a bit sore down below. So they tried treating that with freezing treatment, which helped slightly, but not particularly.

It was literally just by chance, through my studies, that I came across a consultant doing a Fenton’s vestibulectomy procedure, and I realised that patient’s symptoms were exactly the same as what I had, so I managed to get my GP to refer me to her, and then eventually had the procedure in 2013. That improved my symptoms massively, but I still had some residual symptoms, so I ended up having another procedure in December that year, with a steroid injection, a second injection in March and then a final procedure just to remove the remaining skin that was causing me bother in 2014.

Slide 4 (02:15)    Suitability for surgery

Kay [Kay Thomas of the VPS] asked me to briefly cover what might make somebody suitable for surgery. It’s quite an old paper, so I’m not sure how accurate it is these days, but it was written by the doctors at the hospital I was treated at. There’s four main criteria. The main symptom would be pain at the entrance of the vagina during sex, which is superficial dyspareunia; redness of the vestibular region; the pain that you would experience during sex would be reproduced with a cotton wool swab or cotton bud during your appointment; and also trying some of the local anaesthetic cream and seeing if that alleviated the symptoms before having sex.

Slide 5 (02:57)    Recovery after a vestibulectomy

Mostly what I’m going to talk about is what it’s like to actually have the procedure, because I think that’s something that doctors can’t always necessarily tell you in their appointments. In terms of how bad the pain was, it was my first ever operation, so I didn’t really know what to expect when I woke up. It was pretty sore when I woke up. It was kind of a burning-type pain and in terms of pain relief I would use, I found what was best was ibuprofen. I know not everyone can take that, but I also tried paracetamol and at different times, co-codamol, and they all seemed to help a lot. I was also given some local anaesthetic gel which helped to some extent, but I didn’t find it very pleasant to use, so I preferred to put up with the small amount of pain that that relieved. In terms of going to the toilet afterwards, I had a catheter after the operation, so I didn’t need to try and have a wee until the next morning. It did sting afterwards – I’m not going to pretend it didn’t – but I found kind of leaning forwards onto my knees with my elbows on my knees helped with that. Sitting down normally - it probably took a couple of weeks before I could sit down comfortably, but I was able to sort of sit and lean to one side quite quickly afterwards. Again, being a student, I was quite lucky that I just happened to have a catch-up week on placement the week after I had my operation, so that meant I could just go and sit in the library rather than have to go and do any ward work. So I had the operation on the Tuesday, and managed to go back to hospital the next Monday for placement.

Clothes and underwear-wise, I just wore sort of baggy clothes. My mum told me to get maternity pants – you know, the paper ones that people sometimes get after they have a baby? I found those were helpful, because I could just throw them away afterwards. And then, in terms of using pads afterwards, you do get some bleeding from the wound for quite a while, a good few weeks, and also you can sometimes get some oozing from the wound as well, so I probably used them up until about five or six weeks afterwards when I had an appointment with a review. Finally, in terms of stitches, there are a few different types of stitches that the consultant said she used. They’re all dissolvable, but at my appointment, there were some that hadn’t dissolved yet, so she did remove them for me at the time, but had I wanted to, I could have waited for them to dissolve by themselves.

Slide 6 (05:32)    The million dollar question

And the million dollar question is: did it help in terms of sex? Yes - it certainly did! As I’ve said, I had to have another couple of procedures afterwards, but I wouldn’t go back and change my decision to have the vestibulectomy in the first place. Obviously, it would have been nice if it had been completely successful first time, but it doesn’t always happen that way.  

Slide 7     (05:56)    Any questions?

[Q & A with the audience, which is not included in this podcast.]