Effective Surgical Management of Vestibulodynia with the Anterior Obturator Artery Perforator (aOAP) Flap

Vestibulodynia, a form of vulvodynia, is defined as a chronic pain disorder of the vestibule, which may lead to symptoms such as dyspareunia and sexual dysfunction in affected women. The anterior obturator artery perforator (aOAP) flap is a pedicled fasciocutaneous perforator flap that represents a safe and effective method for vulvovestibular reconstruction for a variety of indications. This article aims to explore the therapeutic potential of the aOAP-flap in select cases of vestibulodynia unresponsive to other treatment methods. Two young women underwent surgical therapy with the aOAP-flap after having exhausted various unsuccessful conservative, minimally invasive, and surgical treatment options. A summarized overview of surgical technique, treatment course, patient experience, and outcomes is described. A substantial postoperative improvement of pain and sexual function was observed, with no occurrence of complications during a 1-year follow-up. The clinical experience described in this study shows that the applicability of the aOAP-flap may safely and effectively extend to patients suffering from refractory vestibulodynia, as exemplified by these two cases.