In properly selected patients, surgical treatment for vestibulodynia has the highest success rate of all the treatments for vestibulodynia. However, because many women find adequate relief with other less invasive treatments, surgical excision is generally thought of as the last treatment option for these patients and should be reserved for women with longstanding and severe localized vestibular pain when all other managements have not brought adequate pain relief. The most important criterion for surgical success in treating vestibulodynia (VVS) is identifying the proper surgical candidate. The surgery done to treat vestibulodynia (VVS) is called vestibulectomy and vaginal advancement. It involves cutting out a narrow band of skin that has the painful nerve fibers in it and covering the area with skin from the lower vagina. Before vestibulectomy, it is important to evaluate the patient for vaginismus, which may occur in 50% to 60% of patients with vestibulodynia. If vaginismus is present, it will need to be treated either before or after surgery, in order to obtain the desired outcome. Treatment of vaginismus includes using vaginal dilators and different types of physical therapy. Sexual counseling may aid a patient's recovery by reducing vaginismus and improving poor sexual arousal that can develop after long-term experience of pain with intercourse.