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Vulvar and vaginal surgery Paris — Dr Jérémie Zeitoun
Logo Dr J. Zeitoun
Benign gynaecological surgery · Paris 8th & Neuilly

Gynaecological surgery Vulva & Vagina diagnosis & surgery Dr Jérémie Zeitoun · Surgeon Paris 8th

VIN, condylomas, lichen sclerosus, Bartholin cyst — conditions that respond very well to treatment. Most often as day-case surgery, with a quick return to normal life.

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Vulvar intraepithelial neoplasia

VIN — Precancerous lesions of the vulva

VIN (Vulvar Intraepithelial Neoplasia) refers to lesions of the vulvar skin that are not yet cancer — but may progress to cancer if left untreated. They mainly affect postmenopausal women and are often linked to chronic lichen sclerosus or, in younger women, to human papillomavirus (HPV). First-line treatment is medical, with topical corticosteroids. Surgical excision is indicated when there is diagnostic doubt, to obtain histological analysis and rule out early cancer. Dr Jérémie Zeitoun manages VIN in consultation at the Paris 8th cabinet and at Hartmann Clinic, Neuilly-sur-Seine.

Symptoms & situations

When this concerns you

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Persistent itching or burningVulvar symptoms lasting several weeks or resistant to usual treatments always warrant examination.
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Visible or palpable lesionA whitish, reddish, or pigmented area, a raised plaque, or an ulceration — any change in the appearance of the vulva should be evaluated.
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Positive biopsyDiagnosis is always histological — a biopsy under local anaesthesia confirms the grade of the lesion before deciding on treatment.
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Enhanced surveillance after treatmentVIN can recur — regular clinical surveillance is essential after treatment.
Proposed treatments

The management

Topical corticosteroids — first-line treatment
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The vast majority of VIN cases are treated in first intention with topical application of potent corticosteroids. This medical treatment often induces regression or stabilisation of the lesions, without surgery.

Regular clinical follow-up is organised to monitor treatment response and detect any progression.

First-lineTopical treatmentRegular surveillance
Surgical excision — in case of diagnostic doubt
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When a lesion presents an unusual clinical appearance — indurated, ulcerated, or atypical area — surgical excision is performed straight away, regardless of response to medical treatment. The aim is to obtain a complete histological analysis and formally rule out early cancer.

Excision removes the lesion with a margin of healthy tissue around it, under local or general anaesthesia depending on the location, as day-case surgery.

Diagnostic doubtHistological analysisDay-case
HPV infection

Vulvar condylomas — CO₂ laser Paris

Condylomas are genital warts caused by human papillomavirus (HPV). Benign in the vast majority of cases, they can become large, bothersome, or resistant to local medical treatments. The reference medical treatment is imiquimod, applied locally over 14 weeks — effective but often very painful and poorly tolerated. When it fails or lesions are too extensive, CO₂ laser in Paris or surgical excision takes over. Consultation at Paris 8th and at Hartmann Clinic, Neuilly-sur-Seine.

Symptoms & situations

When this concerns you

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Condylomas resistant to local treatmentsCreams or local applications with no result after several weeks — surgical management is then indicated.
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Large or extensive lesionsGiant, multiple or confluent condylomas — CO₂ laser allows treatment of large surfaces in a single session.
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Functional or psychological discomfortDiscomfort, pain, difficulty during intercourse, or simply the wish to be treated — all these reasons are legitimate.
Surgical procedure

The surgical technique

CO₂ laser
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The laser vaporises condylomas with precision, sparing the surrounding healthy skin. It is the technique of choice for multiple or extensive lesions — a single session is often enough to treat all visible lesions.

Performed as day-case surgery under local or general anaesthesia. Simple recovery, return to normal life within a few days.

Multiple lesionsDay-caseSingle session
Excision or electrocoagulation
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For isolated or pedunculated condylomas, simple excision or electrocoagulation with an electric scalpel is often enough. Quick procedure, under local anaesthesia, in consultation or in the operating theatre depending on the location.

Isolated lesionsLocal anaesthesia
Chronic vulvar dermatosis

Lichen sclerosus

Lichen sclerosus is a chronic inflammatory disease of the vulvar skin. It causes intense itching, white and fragile skin, painful fissures, and may eventually alter vulvar anatomy. If untreated, it represents a risk factor for VIN and gynaecological cancer.

Symptoms & situations

When this concerns you

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Chronic refractory itchingFirst-line treatment is medical (potent topical corticosteroids). Surgery is considered when symptoms persist despite well-conducted treatment.
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Vulvar stenosis or clitoral phimosisLichen can progressively cover the clitoris or narrow the vaginal entrance. These anatomical complications are closely monitored and managed according to their progression.
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Associated suspicious lesionIf a suspicious area appears on a lichen background, a biopsy is essential to rule out VIN or early cancer.
Proposed treatments

The management

Topical corticosteroids — maintenance treatment
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Treatment of lichen sclerosus relies on local application of potent topical corticosteroids. When well conducted, it controls symptoms, reduces lesions and limits the risk of progression to VIN. It is a long-term treatment with regular follow-up.

MaintenanceSymptom controlRegular follow-up
Major vestibular gland

Bartholin gland — Paris & Neuilly

The Bartholin gland is located on each side of the vaginal entrance. Two distinct situations may require surgery: a cyst, when the duct gets blocked and forms a fluid-filled pocket, and bartholinitis, when the gland becomes infected and forms an abscess.

Symptoms & situations

When this concerns you

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Bartholin gland cystA rounded, soft formation at the vaginal entrance. Sometimes asymptomatic and simply monitored. Treated when it becomes bothersome — when walking, sitting, or during intercourse.
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Bartholinitis (abscess)The gland becomes suddenly infected: intense pain, red and hot swelling, sometimes fever. This is an emergency — prompt drainage is essential to relieve pain.
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RecurrenceAfter simple abscess drainage, recurrence is frequent. Marsupialization or gland excision prevents new flare-ups.
Surgical procedure

The surgical technique

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Emergency drainageof bartholinitis: short procedure under local anaesthesia to evacuate the abscess and relieve pain immediately.
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Marsupialisation (elective)of a symptomatic cyst: opening and suturing the edges to preserve the gland — performed as day-case surgery.
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Gland excisionin case of multiple recurrences or when the gland is heavily altered — definitive solution under general anaesthesia.
Patient article · 8 min

Bartholin cyst and bartholinitis: understanding your surgery

Read full article →
Benign lesions

Vulvar cysts — Paris 8th & Neuilly

The vulva can host several types of benign cysts — epidermoid cysts, sebaceous cysts, Skene's duct cysts. Most are asymptomatic and require no treatment. When they grow, become infected, or bothersome, a simple excision is enough.

Symptoms & situations

When this concerns you

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Epidermoid or sebaceous cystRounded formation under the skin, mobile, painless in most cases. Simple removal under local anaesthesia if bothersome or infected.
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Skene's duct cystPara-urethral cyst, sometimes confused with a Bartholin cyst. Managed in the same way depending on symptoms.
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Infected or abscess cystPain, redness, local warmth — prompt management is recommended to prevent spreading.
Surgical procedure

The surgical technique

Excision under local anaesthesia
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The cyst is removed in its entirety — wall included — under local or general anaesthesia, in day-case surgery depending on the location and size. Removing only the content without the wall exposes to recurrence. Pathological analysis of the specimen is performed systematically to confirm the benign nature.

Complete excisionLocal anaesthesiaDay-case
Benign vaginal pathologies

Vaginal surgery Paris — VAIN, Gartner cyst, vaginal septum

The vagina can be the site of precancerous lesions (VAIN), congenital cysts, or anatomical septa. These conditions are often unrecognised, diagnosed during a Pap smear or colposcopy, and respond very well to surgical treatment. They fall within benign gynaecological surgery managed at Paris 8th cabinet and Hartmann Clinic.

Symptoms & situations

When this concerns you

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VAIN (Vaginal Intraepithelial Neoplasia)Precancerous lesions of the vaginal mucosa, often linked to HPV. Diagnosed by colposcopy and biopsy. Surveillance is often sufficient — surgical excision is only indicated when there is doubt about an associated cancer.
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Gartner cystCongenital cyst located on the lateral vaginal wall, remnant of the Wolffian duct. Often asymptomatic, surgically removed when it grows or becomes bothersome.
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Vaginal septumA wall partially or totally dividing the vagina — congenital, sometimes discovered during a gynaecological examination or when trying to conceive. Surgical section is simple.
Surgical procedure

The surgical technique

Surgical excision — VAIN
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VAIN is most often monitored without immediate surgical treatment. Vaginal excision is reserved for cases where there is doubt about an associated cancer — a suspicious, indurated, or atypical area requiring complete histological analysis to formally rule out invasive lesion.

Doubt on associated cancerHistological analysisDay-case
Excision — Gartner cyst
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The cyst is removed via the vaginal route, without external incision. The procedure is performed under general anaesthesia as day-case surgery. Simple recovery, return home the same day.

Natural routeNo scarDay-case
Vaginal septum section
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The septum is sectioned via the vaginal route under direct vision, under general anaesthesia. Simple and quick, this procedure restores normal anatomy and removes functional discomfort. Day-case surgery.

Natural routeRestored anatomyDay-case
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CO₂ Laser
Millimetric precision, preserves healthy tissue
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Day-case
Return home the same day in most cases
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Simple recovery
Transient local discomfort, rapid healing
From consultation to recovery

Your pathway

01
Consultation
Complete clinical examination of the vulva and vagina. Colposcopy if a visible abnormality or history of lesion. Biopsy under local anaesthesia if a suspicious area requires histological analysis. Discussion of therapeutic options.
02
Pre-operative work-up
Anaesthesia consultation mandatory for any procedure under general anaesthesia. Standard blood work-up. Depending on the planned procedure: recent cervico-vaginal smear, HPV serology. Prescription of preoperative local care if needed.
03
Surgery
Day-case in the vast majority of cases at Hartmann Clinic, Neuilly-sur-Seine. CO₂ laser for condylomas and extensive lesions, surgical excision for cysts and VIN, marsupialization for Bartholin cyst — depending on the pathology and its extent.
04
Postoperative course
Return home the same day. Simple local care (gentle cleaning, healing cream). Moderate discomfort for 2 to 5 days. Abstinence recommended for 3 to 4 weeks. Return to sedentary work in 3 to 7 days depending on the procedure.
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Surveillance
Follow-up consultation at 4–6 weeks to check healing. Control colposcopy at 3–6 months for VIN and VAIN. HPV surveillance and annual smears. Long-term follow-up for lichen sclerosus.
Frequently asked questions

What you often ask

What is VIN and is it serious?
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VIN refers to abnormal cells on the surface of the vulva — it is not cancer, but a precancerous lesion that can progress if left untreated. When detected and treated in time, the outcome is excellent. This is why regular gynaecological follow-up is important, especially in the case of HPV infection or lichen sclerosus.
Is CO₂ laser painful?
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The procedure itself is performed under anaesthesia — local or general depending on extent — and is therefore painless. In the days that follow, a local burning sensation is possible, similar to sunburn. It disappears within a few days with simple care.
Can condylomas and VIN be treated at the same time?
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Yes — this is often the case, since both are linked to HPV. CO₂ laser allows treatment of several areas in a single session, under the same anaesthesia.
Can a Bartholin cyst come back after treatment?
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Marsupialization significantly reduces the risk of recurrence. Simple drainage without marsupialization tends to recur more often. In case of multiple recurrences despite marsupialization, complete removal of the gland may be discussed.
Are these procedures reimbursed?
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Yes. Procedures for VIN, VAIN, condylomas, Bartholin cyst and vulvar cysts are covered by French national health insurance (Assurance Maladie). Dr Zeitoun works in sector 2 — additional fees are regulated and a quote is provided before any surgical decision.
What is vulvar lichen sclerosus and how is it treated?
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Lichen sclerosus is a chronic inflammatory disease of the vulvar skin causing intense itching, white and fragile skin, and painful fissures. The maintenance treatment relies on potent topical corticosteroids. Surgery is reserved for anatomical complications (stenosis, clitoral phimosis) or when a suspicious lesion requires biopsy.
What is the difference between bartholinitis and Bartholin cyst?
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A Bartholin cyst is a fluid-filled pocket formed by obstruction of the gland duct — often painless. Bartholinitis is an infection of the gland with abscess formation — intense pain, red and hot swelling, sometimes fever. It is an emergency requiring prompt drainage.
Can condylomas recur after CO₂ laser?
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Yes — laser treats visible lesions but HPV can persist in the body. Regular surveillance and, if necessary, complementary treatment of the partner are part of the overall management. HPV vaccination, recommended before exposure to the virus, remains the best means of prevention.
Can vulvar surgery be performed as day-case surgery?
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Yes, in the vast majority of cases. CO₂ laser, marsupialization, vulvar cyst excision, Gartner cysts — all these procedures are performed as day-case surgery at Hartmann Clinic (Neuilly-sur-Seine), with return home the same day.

One question, one consultation

Every situation is different. The consultation allows examination, explanation, and proposal of the most suitable solution.

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Fees & Reimbursement

Transparency on fees

Dr Zeitoun practises in French sector 2 (non-OPTAM) and applies fee supplements for all consultations and procedures. The French national health insurance (Assurance Maladie) reimburses on the basis of the official Social Security tariff — this reimbursement is improved in case of cancer (ALD 30 long-term illness), but does not cover fee supplements. Your private health insurance (mutuelle) may cover all or part of these supplements depending on your contract.

Fee supplements
Dr Zeitoun applies fee supplements — including for patients with long-term illness status (ALD). A detailed quote is systematically provided before any procedure. No quote is issued without a prior consultation at the practice or via teleconsultation.
Private health insurance
Your mutuelle (private health insurance) may cover all or part of the supplements depending on your contract. Please check with them.
KEY POINTS IN 30 SECONDS

Vulvar and vaginal surgery in brief

  • ● The vulva can present with cysts (Bartholin), lichen sclerosus, labia minora hypertrophy, or precancerous lesions.
  • ● Bartholin marsupialization treats recurrent cysts/abscesses.
  • ● Labiaplasty is indicated for functional discomfort (sport, clothing, intercourse).
  • ● Lichen sclerosus requires surveillance because of a (low) risk of malignant transformation.
  • ● Any suspicious vulvar lesion requires systematic biopsy.
FREN