Bilateral plication of the puborectal muscles: A new surgical concept for treating vulvar widening.

OBJECTIVES: This study describe a new myorraphy technique by bilateral plication of the puborectalis bundles (PRP) of the levator ani muscle to treat vulvovaginal widening. The aim of this work was to report our preliminary experience in terms of morbidity and results (anatomical and functional) in the short and medium term. MATERIALS AND METHODS: This single centre retrospective study concerned 69 women who underwent PRP between January 2011 and December 2014. The main criterion for judging success was the GH before and after surgery (Genital Hiatus in the POP-Q classification: Pelvic Organ Prolapse Quantification System). The secondary criteria were the quality of sexual intercourse and the morbidity. RESULTS: The average GH post-surgery was 31, 35 and 35mm at 6 weeks, 6 and 12 months respectively compared to 65±5mm preoperatively (P<0.00001). Among the 27 patients who were sexually active prior to surgery, 18.52% deemed the quality of sexual intercourse satisfactory. After surgery, more than 88% of the patients observed an improvement (P<0.00001). After the surgery the reported rate of minor complications was under 3%. CONCLUSION: This preliminary study of PRP confirms the feasibility of the procedure, its low morbidity and the stability of the anatomical outcomes at 12 months.

Web-enabled Glazer surface electromyographic protocol for the remote, real-time assessment and rehabilitation of pelvic floor dysfunction in vulvar vestibulitis syndrome. A case report.

BACKGROUND: The browser-based software for the Glazer pelvic floor muscle surface electromyography (sEMG) protocol can be used for remote, real-time assessment and treatment over the Internet. CASE: The initial application of this system is reported for a patient meeting clinical diagnostic criteria for vulvar vestibulitis syndrome. The patient underwent pelvic floor muscle sEMG evaluation in the Washington, D.C., office of the second author, remotely controlled by the first author from his office in New York City. Pelvic muscle sEMG findings were consistent with previous reports on vestibulitis patients, and rehabilitative exercises were prescribed. Follow-up evaluations and home training normalized the sEMG and resulted in elimination of pain. CONCLUSION: Remote, real-time pelvic floor muscle sEMG in the diagnosis and treatment of vulvar vestibulitis is a novel application of telemedicine with demonstrated efficacy, permitting this technology to be available to all practitioners.

Dysesthetic vulvodynia. Long-term follow-up after treatment with surface electromyography-assisted pelvic floor muscle rehabilitation.

OBJECTIVE: To determine the long-term follow-up status of dysesthetic vulvodynia patients who were asymptomatic at the termination of treatment using surface electromyography (sEMG)-assisted pelvic floor muscle rehabilitation. STUDY DESIGN: A chart review of the years 1994-1996 identified 62 patients with a diagnosis of dysesthetic vulvodynia on initial evaluation and who were asymptomatic at the termination of treatment. Forty-three of these patients responded to a survey requesting information on their pain, maintenance activities and treatments, daily functioning and sexual status since treatment termination. RESULTS: Thirty-eight of the 43 patients (88.4%) reported experiencing no vulvar pain since completion of treatment. Three patients reported a single episode of pain, and two patients reported two episodes each. All five of these patients reported the absence of any vulvar pain for a mean period of 19.8 months prior to completion of the survey. One hundred percent of the 43 dysesthetic vulvodynia patients studied reported being pain free a mean of 39.5 months after successful treatment termination. No vulvar pain-related treatments or significant restrictions on daily activities were reported. All patients reported sexual interest, pleasure and activity. CONCLUSION: Surface electromyography-assisted pelvic floor muscle rehabilitation is an effective and long-term cure for dysesthetic vulvodynia.