Advertisement

Multilevel local anesthetic nerve blockade for the treatment of vulvar vestibulitis syndrome

Published:October 15, 2007DOI:https://doi.org/10.1016/j.ajog.2007.06.008

      Objective

      Vulvar vestibulitis syndrome is a major cause of dyspareunia. This pilot study was designed to evaluate a novel treatment approach.

      Study Design

      This is a prospective study of 27 women with vulvar vestibulitis. The protocol included 5 treatment sessions with caudal epidural, pudendal nerve block, and vestibular infiltration of local anesthetic agents.

      Results

      There were significant improvements in vestibular pain as determined by the vulvalgesiometer, McGill pain questionnaire, self-report, and the Female Sexual Functioning Inventory.

      Conclusion

      Serial multilevel nerve blocks administered for the treatment of vulvar vestibulitis is a conceptually neurophysiologically based modality that may be effective and merits a placebo-controlled study.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Bachmann G.A.
        • Rosen R.
        • Arnold L.D.
        • et al.
        Chronic vulvar and other gynecologic pain.
        J Reprod Med. 2006; 51: 3-9
        • Friedrich Jr, E.G.
        Vulvar vestibulitis syndrome.
        J Reprod Med. 1987; 32: 110-114
        • Bergeron S.
        • Binik Y.M.
        • Khalife S.
        • et al.
        A randomized comparison of group cognitive-behavioral therapy, surface electromyographic biofeedback, and vestibulectomy in the treatment of dyspareunia resulting from vulvar vestibulitis.
        Pain. 2001; 91: 297-306
        • Glazer H.I.
        • Rodke G.
        • Swencionis C.
        • Hertz R.
        • Young A.W.
        Treatment of vulvar vestibulitis syndrome with electromyographic biofeedback of pelvic floor musculature.
        J Repro Med. 1995; 40: 283-290
        • Ben-David B.
        • Friedman M.
        Gabapentin therapy for vulvodynia.
        Anesth Anal. 1999; 89: 1459-1460
        • McKay M.
        Dysesthetic (“essential”) vulvodynia: treatment with amitriptyline.
        J Repro Med. 1993; 38: 9-13
        • Zolnoun D.
        • Hartmann K.E.
        • Steege J.F.
        Overnight 5% lidocaine ointment for treatment of vulvar vestibulitis.
        Obstet Gynecol. 2003; 102: 84-87
        • Bornstein J.
        • Goldik Z.
        • Stolar Z.
        • Zarfati D.
        • Abramovici H.
        Predicting the outcome of surgical treatment of vulvar vestibulitis.
        Obstet Gynecol. 1997; 89: 695-698
        • Traas M.A.F.
        • Bekkers R.L.M.
        • Dony J.M.J.
        • et al.
        Surgical treatment for the vulvar vestibulitis syndrome.
        Obstet Gynecol. 2006; 107: 256-262
        • Haefner H.K.
        Critique of new gynecologic surgical procedures: surgery for vulvar vestibulitis.
        Clin Obstet Gynecol. 2000; 43: 689-700
        • Zolnoun D.
        • Hartmann K.
        • Lamvu G.
        • As-Sanie S.
        • Maixner W.
        • Steege J.
        A conceptual model for the pathophysiology of vulvar vestibulitis syndrome.
        Obstet Gynecol Surv. 2006; 61: 395-401
        • Pukall C.F.
        • Strigo I.A.
        • Binik Y.M.
        • Amsel R.
        • Khalife S.
        • Bushness M.C.
        Neural correlates of painful genital touch in women with vulvar vestibulitis syndrome.
        Pain. 2005; 115: 118-127
        • Foster D.C.
        • Dworkin R.H.
        • Wood R.W.
        Effects of intradermal foot and forearm capsaicin injections in normal and vulvodynia-afflicted women.
        Pain. 2005; 117: 128-136
        • Giesecke J.
        • Reed B.D.
        • Haefner H.K.
        • Giesecke T.
        • Clauw D.J.
        • Gracely R.H.
        Quantitative sensory testing in vulvodynia patients and increased peripheral pressure pain sensitivity.
        Obstet Gynecol. 2004; 104: 126-133
        • Pukall C.F.
        • Binik Y.M.
        • Khalife S.
        • Amsel R.
        • Abbott F.V.
        Vestibular tactile and pain thresholds in women with vulvar vestibulitis syndrome.
        Pain. 2002; 96: 163-175
        • Melzack R.
        The short-form McGill Pain Questionnaire.
        Pain. 1987; 30: 191-197
        • Wiegel M.
        • Meston C.
        • Rosen R.
        The female sexual function index (FSFI): cross-validation and development of clinical cutoff scores.
        J Sex Marital Ther. 2005; 31: 1-20
        • Beck A.T.
        • Ward C.H.
        • Mendelson M.
        • Mock J.
        • Erbaugh J.
        An inventory for measuring depression.
        Arch Gen Psychiatry. 1961; 4: 561-571
        • Pukall C.F.
        • Binik Y.M.
        • Khalife S.
        A new instrument for pain assessment in vulvar vestibulitis syndrome.
        J Sex Marital Ther. 2004; 30: 69-78
        • Granot M.
        • Friedman M.
        • Yarnitsky D.
        • Zimmer E.Z.
        Enhancement of the perception of systemic pain in women with vulvar vestibulitis.
        BJOG. 2002; 109: 863-866
        • Amir R.
        • Argoff C.E.
        • Bennett G.J.
        • et al.
        The role of sodium channels in chronic Inflammatory and neuropathic pain.
        J Pain. 2006; 7: S1-S29
        • Zhang J.-M.
        • Li H.
        • Munir M.A.
        Decreasing sympathetic sprouting in pathologic sensory ganglia: a new mechanism for treating neuropathic pain using lidocaine.
        Pain. 2004; 109: 143-149
        • Ramer M.S.
        • Thompson S.W.
        • McMahon S.B.
        Causes and consequences of sympathetic basket formation in dorsal root ganglia.
        Pain. 1999; : S111-S120
        • Abdi S.
        • Lee D.H.
        • Chung J.M.
        The anti-allodynic effects of amitriptyline, gabapentin, and lidocaine in a rat model of neuropathic pain.
        Anesth Analg. 1998; 87: 1360-1366
        • Glazer S.
        • Portenoy R.K.
        Systemic local anesthetics in pain control.
        J Pain Symptom Manage. 1991; 6: 30-39