Staged Injectable Biostimulation Followed by Surgical Correction for Post-Obstetric Introital Deformity and Vulvovaginal Hypotrophy: A Case Report

Abstract

Vulvovaginal symptoms may occur outside menopause after obstetric trauma or hormonal changes. A 40-year-old woman presented with vulvar burning and dyspareunia persisting for six years after vaginal delivery, followed by two years of breastfeeding and approximately four years of oral contraception. Examination showed vulvovaginal hypotrophy resembling genitourinary syndrome of menopause and a symptomatic post-obstetric introital deformity with hymenal caruncles. Three monthly injections of non-crosslinked hyaluronic acid with 0.01% calcium hydroxyapatite were administered to the vulva and lower third of the vagina, followed by suture-free en bloc excision of the caruncles using bipolar radiofrequency electrosurgery. The Vaginal Health Index increased from 5 to 20 and 23, the six-item Female Sexual Function Index from 2 to 22 and 30, and dyspareunia visual analog scale scores decreased from 10 to 3 and 0 at three months postoperatively, without complications. This hypothesis-generating case cannot establish that preoperative biostimulation improves surgical outcomes.