Radiofrequency Therapy for Severe Idiopathic Vulvodynia

Kestřánek, Jan; Špaček, Jiří; Ryška, Pavel; Adamkov, Jaroslav; Matula, Vojtech; Buchta, Vladimír

doi:10.1097/lgt.0b013e3182796c3e

Cited by 5 publications

(2 citation statements)

References 19 publications

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“…Only in 2013 did the first report appear of successful use of pulsed radiofrequency in the treatment of severe refractory (neuropathic) vulvodynia-i.e., nosologically distinct from LPV according to the "2015 classification" [2,29]. Since then, pulsed radiofrequency has been widely used with no clear rationale in this frankly neuropathic indication.…”

Section: Discussionmentioning

confidence: 99%

Dynamic quadripolar RadioFrequency and vulvodynia

Seta¹,

Raichi²

2018

Obstet Gynecol Rep

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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...

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Section: Discussionmentioning

confidence: 99%

Dynamic quadripolar RadioFrequency and vulvodynia

Seta¹,

Raichi²

2018

Obstet Gynecol Rep

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“…Invasive methods include the insertion of spinal cord stimulators and subcutaneous vulval stimulators . In a recent report, radiofrequency therapy, in which a high‐frequency electrical current is passed via a specialised percutaneous needle under computed tomographic guidance to the hypogastric ganglion in the sacral region, was effective for a patient with longstanding recalcitrant vulvodynia . Non‐invasive methods such as transcranial cortical stimulation have also been described .…”

Section: Treatmentmentioning

confidence: 99%

Current concepts in vulvodynia with a focus on pathogenesis and pain mechanisms

Thornton

Drummond

2015

Aust J Dermatology

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Vulvodynia is a common and debilitating chronic pain syndrome characterised by neuropathic-type pain. Localised provoked vulvodynia is the most common type, followed by generalised unprovoked vulvodynia. Vulvodynia is a diagnosis of exclusion. The cause is unknown but current research suggests an underlying predisposition to increased sensitivity to pain and peripheral and central neural sensitisation. Musculoskeletal factors also play an important role. Vulvodynia has a significant impact on the quality of life, mood, functional ability and relationships of patients and their partners. It is highly associated with anxiety and depression. Treatment needs to follow a biopsychosocial model and be tailored to the patient. A multimodal and multidisciplinary approach is often most effective. We have suggested a therapeutic ladder.

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Trichomoniasis in older individuals: a preliminary report from Iran

et al. 2016

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Infection with Trichomonas vaginalis is one of the most common sexually transmitted diseases (STDs) in humans. The prevalence of infection in Iran has been reported 0.009-8 % depending on deferent socio-cultural conditions. This study aimed to determine the frequency of T. vaginalis according to age in patients referred to clinics, hospitals and medical diagnostic laboratories in Karaj city, Iran. For this purpose, fifty positive samples were collected from July 2012 to June 2014 from clinics, medical diagnostic laboratories and hospitals, then transferred to laboratory of parasitology and cultured in TYM medium. The results showed that all isolates were successfully cultured. Among 50 positive specimens, 43 cases were female and 7 cases male. The most positive cases (34 %) belonged to the ages over 50 year's group. The lowest positive cases (2 %) belonged to the ages of less than 20 years group. In Conclusion, unlike other STDs, which have a higher prevalence among adolescents and young adults, the rates of trichomoniasis are more evenly distributed among sexually active women of all age groups. However, frequency of this infection in women aged over 50 years (age of menopause) is notable and complementary studies are needed.

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Radiofrequency Therapy for Severe Idiopathic Vulvodynia

Cited by 5 publications

References 19 publications

Dynamic quadripolar RadioFrequency and vulvodynia

Dynamic quadripolar RadioFrequency and vulvodynia

Current concepts in vulvodynia with a focus on pathogenesis and pain mechanisms

Trichomoniasis in older individuals: a preliminary report from Iran

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