Therapeutic Hymenotomy with Hymenoplasty/Hymenorrhaphy followed by Pain Management with Anesthetic Nerve Blocks: A New Approach to Resolve Introital Dyspareunia

Abstract Some cases of dyspareunia, called also painful intercourse, are due to a congenital narrowing of the vaginal introitus. In this case, we can talk about introital dyspareunia. A non-surgical treatment is currently doomed to failure. On the other hand, the surgical approach alone is often unable to resolve the problem. As a matter of fact, many repeated attempts to obtain an intercourse provoke a chronic allodynia/hyperalgesia especially in hymenal caruncles around the mucous membrane lining the vaginal opening. Consequently, it is first necessary to enlarge the vaginal introitus to correct the anatomical narrowing; and, later, to practice anesthetic nerve blocks in the pelvic-perineal area to desensitise the hymenal residues. Fifteen consecutive selected patients affected by chronic hymenal dyspareunia were submitted to such surgical approach followed by monthly sessions of appropriate anesthetic nerve blocks. In all cases, the results were completely successful in six months