6/7 women aged 20-29 with vulvodynia and hip pain experienced significant relief by having therapeutic arthroscopy for hip femeroacetabular syndrome. None of the 19 older cases sustained any benefit.
J Low Genit Tract Dis. 2015 Apr 7. [Epub ahead of print]
Vulvodynia and Concomitant Femoro-Acetabular Impingement: Long-Term Follow-up After Hip Arthroscopy.
Coady D(1), Futterman S, Harris D, Coleman SH.
- femoroacetabular syndrome is where the upper part of the hip joint pinches the bone above it either because there is too much bone in the upper part of the hip joint or the bone above. This is “sanded” down and this helps the impingment.
- “Exam findings considered suspect for hip disorders included a positive FABER test (pain with flexion, abduction, external rotation) and tenderness of the obturator internus on pelvic floor exam.” – the latter I had not considered but certainly could connect pelvic pain to hip pains.
- Rx – combinations of pincer resection, cam resection, labrum repair, and iliopsoas tendon release.
- Their theory: – “Chronic low-grade hip discomfort provokes postural and gait changes that put stretch, tension, and torsion on the obturator internus, other hip rotators, deep pelvic floor muscles such as the iliococcygeus, and superficial muscles such as the bulbocavernosus, just under the vulvar skin. The resulting dysfunctional and with time dystrophic changes in the pelvic floor muscles stimulate nociceptors, and may compress branches of the pudendal nerve, interfering with their mobility and ability to glide within the myofascia. This result may be responsible for the burning neuropathic type of pain that patients with GUV so commonly describe.” I think there also could be a convergence of afferents with one level effecting other.
Comment – In vulvodynia under thirty, check for hip problems and get a hip orthopod to resect any impingment.