Treatment of Localized Vulvar Pain with Neural Therapy: A Case Series and Literature Review

Novoa, Modesto Rey; Muñoz-Sellart, Montserrat; Soriano, Marta Catalán; Vinyes, David

doi:10.1159/000514945

Cited by 10 publications

(8 citation statements)

References 48 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A sample with 45 patients is rather heterogenous concerning the comorbidities, such as HSV, and lichen sclerosus, and yields small subgroups of primary versus secondary vulvodynia. Yet the sample is larger than the studies of McDonald & Rapkin 23 with 32 patients, and Rey-Novea 31 with five patients. In our study, we prospectively included all consecutive cases of vulvodynia in the respective period.…”

Section: Discussionmentioning

confidence: 84%

“…In contrast to the repeated application of injections on defined nerves, for example the impar ganglion 42 or the pudendal nerve, 23 , 24 we performed an individual-based regimen, with different nerve blockades depending on the progress of therapy effects, and on the individual symptoms of the respective patient. Rey-Novea et al 31 successfully treated women with localized provoked vulvodynia using a simple technique of local injections. There needs to be further investigation to see if this technique is also applicable in a mixed cohort with women with generalized, or spontaneous pain as in our patient group.…”

Section: Discussionmentioning

confidence: 99%

“…28 , 29 A first case report with successful TLA in vulvodynia was published in 2013. 30 Application routes were: Local infiltrations, 24 , 31 intracutaneous injections, or regional blockades such as transperineal pudendal nerve blockade. 32 This technique consists of repeatedly injecting LA into the respective nerve, is highly effective (90% anesthesia of the perineum), and makes therapy more comfortable for patients than trans-gluteal 21 or intravaginal techniques.…”

Section: Introductionmentioning

confidence: 99%

“… 32 This technique consists of repeatedly injecting LA into the respective nerve, is highly effective (90% anesthesia of the perineum), and makes therapy more comfortable for patients than trans-gluteal 21 or intravaginal techniques. 23 A local approach was chosen by Rey-Novea et al 31 who injected LAs in tender vulvar areas with good success rates for six months or more.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Therapy With Local Anesthetics to Treat Vulvodynia. A Pilot Study

et al. 2022

View full text Add to dashboard Cite

Introduction: Vulvodynia (chronic vulvar pain) is a sexually debilitating disorder with a prevalence of »x223C10%.Aim: To investigate the effectiveness of therapy with local anesthetics (TLA) in women with severe vulvodynia, we conducted a prospective, non-controlled observational study. Methods: 45 patients with severe chronic vulvodynia (primary and secondary vulvodynia, 0−10 numeric analogue scale (NAS) ≥6, median 7.9, duration ≥6 months, median 65.2 months) in an outpatient practice in Germany were treated with TLA in 3−12 sessions using procaine 1% as local anesthetic. Effectiveness was analyzed with Wilcoxon signed rank tests and Wilcoxon rank sum tests. Outcomes: Therapeutic success as a reduction of pain to ≤4 NAS lasting for ≥6 months after end of therapy.Results: TLA successfully reduced vulvodynia in 36 of 45 patients (80 %, responders). The NAS reduction was from 7.9 to 2.4 (P < .001). Even patients denominated as non-responders experienced a significant reduction in NAS (P = .03). In responders, long-term success was observed for 6.8−125 months (median 24.1 months). No adverse events occurred. Clinical Translation: A promising new treatment for a hard-to-treat chronic female pain disorder. Strengths and Limitations: Limitation: Monocentric, non-controlled observational design; Strength: the high number of patients treated. Conclusion:The high success rate of TLA in this investigation offers new perspectives on the etiology of vulvodynia as a complex pain syndrome affecting several nerves of the pelvic floor, and also provides early insight into the effectiveness of TLA in women with vulvodynia.

show abstract

Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Therapy With Local Anesthetics to Treat Vulvodynia. A Pilot Study

et al. 2022

View full text Add to dashboard Cite

show abstract

“…LISWT, 48 ESWT, 38 and treatment with itraconazole 57 may be considered, as well as botulinum toxin A injections in the m. levator ani , which significantly reduced vulvar pain in women with vulvodynia refractory to conventional treatment 58 . Prospective study 74 and case series 79 showed promising results of therapy with local anesthetics to reduce vulvar pain in women with vulvodynia; well‐designed studies evaluating this intervention are needed.…”

Section: Discussionmentioning

confidence: 99%

Individualized multidisciplinary therapy for vulvodynia

Penteado,

Bonduki,

de Araújo

et al. 2023

J of Obstet and Gynaecol

View full text Add to dashboard Cite

ObjectiveThe main objective of this review was to develop strategies for individualizing multidisciplinary therapy for vulvodynia.MethodsWe conducted two literature searches; the first one focused on clinical trials assessing vulvodynia treatments published after the recommendations of the expert committee of the Fourth International Consultation on Sexual Medicine. The second search targeted studies identifying predictive factors and mediators of vulvodynia treatments, published from the earliest date to October 2022.ResultsBased on data from 55 relevant studies, we developed models of individualized multidisciplinary therapy targeting groups of women less responsive to multidisciplinary therapy (characterized by women with higher vulvar pain intensity, impaired sexual functioning, and vulvodynia secondary subtype) and to physical therapy, as an isolated treatment (characterized by women with increased pelvic floor muscle tone and vulvodynia primary subtype). Each individualized multidisciplinary therapy model comprises three components: psychotherapy, medical care, and physical therapy. These components provide distinct therapeutic modalities for distinct subgroups of women with vulvodynia; the women subgroups were identified according to the characteristics of women, the disease, partners, and relationships. Additionally, for women with provoked vestibulodynia who exhibit less benefits from vestibulectomy (such as those with higher levels of erotophobia, greater vulvar pain intensity, and the primary subtype) and encounter resistance to individualized multidisciplinary therapy, we suggest additional conservative treatments before performing vestibulectomy.ConclusionOur study is a pioneer in the development of models that allow the individualization of multidisciplinary therapy for vulvodynia and represents a significant advance in the clinical practice of gynecologists, physiotherapists, and psychologists.

show abstract