Treatment of Vulvar Vestibulitis Syndrome With Electromyographic Biofeedback of Pelvic Floor Musculature

Sexual Pain Disorders: Dyspareunia and Vaginismus

“…From the pathophysiologic point of view, vulvar vestibulitis involves the up-regulation of: a) the immunological system, ie of introital mast-cells (with hyperproduction of both inflammatory molecules and nerve growth factors (NGF) [25][26][27]; b) the pain system, with proliferation of local pain fibers induced by the NGF [27][28], which may contribute to the hyperalgesia and allodynia, associated with neuropathic pain, reported by VV patients [2,3,6]; c) hyperactivity of the levator ani, which can be antecedent to vulvar vestibulitis and comorbid with vaginismus of a mild degree [6,16,24], or secondary to the introital pain. In either case, addressing the muscle component is a key part of the treatment [28][29][30].…”

“…[36]. Post coital-cystitis should suggest a hypoestrogenic condition and/or the presence of hypertonic pelvic floor muscles: it should specifically be investigated in post-menopausal women who may benefit from topical estrogen treatment [37] and rehabilitation of the pelvic floor, aimed at relaxing the myalgic perivaginal muscles [28][29][30]. Vulvar pruritus, vulvar dryness and/or feeling of a burning vulva should be investigated, as they may suggest the presence of vulvar lichen sclerosus, which may worsen introital dyspareunia [19].…”

“…• intensity of the pelvic floor hypertonicity (in four degree, according to Lamont [15,[28][29][30];…”

“…Anthalgic treatment should be prescribed: locally, with electroanalgesia [39] or, in severe cases, with the ganglion impar block [3]; systemically with tricyclic antidepressant, gabapentin or pregabalin in the most severe cases, with a neuropathic component [3,6,38,43]; c) the up-regulation of the muscular response, with hyperactvity of the pelvic floor, which may precede vulvar vestibulitis, when the predisposing factor is vaginismus [6,24] or be acquired in response to genital pain [6,20,33]. In controlled studies, electromyographic feed-back [28][29][30] has been demonstrated to significantly reduce pain in VV patients. Self-massage, pelvic floor stretching and physical therapy may also reduce the muscular component of coital pain [6,40,42].…”

Vulvar vestibulitis: aetiology, diagnosis and treatment

“…This can result in increased pelvic¯oor muscle contractions, decreased muscle resting tension level and subjective decreases in pain of 83% 47 . Following this therapy, 22 of 28 patients were able to resume sexual intercourse and 17 reported painfree intercourse.…”