Surgical procedures include focal excision, vestibuloplasty, vestibulectomy and perineoplasty.

Vestibulectomy excises the vestibule with vaginal advancement. The excision includes a U shaped area of the vestibule from 5 mm lateral to the urethra to the posterior fourchette. The hymenal ring is included. The margins of the vestibule are reapproximated to the vaginal wall.

Perineoplasty excises the vestibule from below and lateral to the urethral meatus, extending along the perineum to half the distance between the posterior fourchette and the anal canal. The vaginal mucosa is undermined 1-2 cm, advanced and sutured to the skin.