Dynamic quadripolar RadioFrequency and vulvodynia

Abstract

Background: Among the several subtypes of vulvodynia or idiopathic vulvar pain lasting for at least 3 months, Localised Provoked Vulvodynia (LPV) is the most highly prevalent clinical variant identified by the "2015 classification". The pathophysiology underlying LPV is still elusive and unclear. The association with recurrent vulvovaginal candidiasis and aerobic vaginitis is most likely prominent in leading to the vestibular nociceptive hypersensitivity that is a distinctive diagnostic marker of LPV. The exploratory non-randomised study herein described was designed to investigate if the demonstrated vulvar remodelling and rejuvenating properties of DQRF (Dynamic Quadripolar RadioFrequency) treatment might be of benefit to control the vestibular pain of LPV. The working hypothesis behind the study was that correcting the mucosal hypotrophy frequent in many LPV women would restore a thriving vestibular and vaginal microorganism ecosystem and break the vicious cycle of recurrent yeast and aerobic infections that leads to exaggerated nociceptive response and LPV hyperesthesia, hyperalgesia, and dyspareunia.Methods: Prospective cohort of 30 consecutively enrolled premenopausal women with vestibulitis and/or moderate to severe hyperesthesia and pain, dyspareunia or pelvic floor hypercontractility related to recurrent vulvovaginal candidiasis and/or aerobic vaginitis. The first 20 women were treated with four 10-min DQRF sessions (EVA™ device) spaced at least 7 to 10 days; the last 10 women, acting as controls, underwent a standard 4-week program of pelvic floor rehabilitation. After the baseline clinical, microbiologic and microscopic assessment, a second follow-up visit was planned no more than 15 days after the fourth (last) DQRF treatment session. Assessed parameters included Lactobacillus and aerobic microflora, polymorphonuclear and clue cells, pH, Nugent score, provoked pain (Swab Test), and severity of vaginal atrophy (Vaginal Health Index).Results: All women completed the planned four DQRF/EVA™ or physical therapy sessions without adverse effects. Both treatment strategies significantly reduced the Swab Test provoked pain. The reduction in pain severity seemed to be more marked at the follow-up visit in the DQRF treatment group (mean pain score difference, -3,55) compared with control women (mean pain score difference, -3,20), although with only marginal statistical significance (p≈0.054). Both treatment strategies improved the vestibular and vaginal environment and mucosal hypotrophy, though more definitely in the DQRF-treated women, as observed for the Vaginal Health Index (DQRF vs. physical therapy pre/post score difference: +5.50 vs. +5.0, p <0.05) and for the microbiologic and microscopic markers of deranged intimate ecology (lactobacilli, Nugent score, polymorphonuclear and clue cells, etc.). Conclusions:The endoderm-derived vestibule, embriologically distinct from the ectoderm-derived external vulva and the mesoderm-derived vagina, may have a quite peculiar inflammatory and immune reactivity compared w...