New approaches include topical neuromodulation which means “Podophyllotoxin (5 mg/mL) applied locally to tender points of vestibule after 5% acetic acid application. Treated area was covered with a mild estrogen cream and covered with gauze pads until the next day” . This may be repeated monthly up to 3 times. I found little articles but came across a patent that found half of vulvodynias and post hysterectomy pain patients were better though article here did not find much.
Another approach, local injection of tender spots with 2 – 4 mL of cortisone (betamethasone) and long-acting anesthetic agent (bupivacaine), 1:1 , injected submucously to the painful site has been suggested. Other measures included topical 6% gabapentin, topical 5% lidocaine before sex, amitriptyline 40 mg, pregabalin 150-300 mg /day, laser treatments (less often used), physiotherapy, sacral neuromodulation, and finally surgery.
J Low Genit Tract Dis. 2017 Jul;21(3):209-214.
doi: 10.1097/LGT.0000000000000318.
Vulvodynia-Younger Age and Combined Therapies Associate With Significant
Reduction in Self-Reported Pain.
Aalto AP et al
https://www.ncbi.nlm.nih.gov/pubmed/28644192
Management program:
- Topical gabapentin is not new and I discussed it here:
New Treatment For Vulvodynia – 6% Gabapentin in Lipoderm
http://painmuse.org/?p=96 - amitriptyline working up to 40 mg could drop pain additionally 1/10 when used
- Pregabalin working up to 150-300 mg/day could drop pain additionally 1/10
Neuromodulation treatment was described in a patent:
Saarela, Eero.
Analgesic use of podophyllotoxin for treating pain conditions in female genital organs.
U.S. Patent No. 6,362,222. 26 Mar. 2002.
https://www.google.com/patents/US6362222
- total of 151 patients were treated over a period of two years, and among these 75% had typical vulvodynia symptoms
- washes area with 3% acetic acid though 2017 article used 5% (vinegar is 5%)
- Podophyllotoxin (5 mg/mL) applied locally to tender points of vestibule – this is usually used to treat warts by inducing an immune reaction. Marked names include Podofilox and Condylox
- “Treated area was covered with a mild estrogen cream and covered with gauze pads until the next day”
- Usually it makes things sore so repeated treatments need to be delayed.
- Could be repeated monthly up to 3 times from sounds of it. Average in patent study was 2.6 times
- patent study got 2/3 better but clinical study did not suggest much
Injections of local into sensative areas using 2 – 4 mL of cortisone (betamethasone) and long-acting anesthetic agent (bupivacaine), 1:1 – given up to 3 times every 3-4 weeks
tradc name Celestone has “betamethasone 5.7 mg, as betamethasone sodium phosphate 3.9 mg (in solution) and betamethasone acetate 3 mg (in suspension) in an aqueous vehicle containing sodium phosphate, sodium phosphate monobasic, disodium edetate, benzalkonium chloride and Water for Injections.”
Laser apparently is less used.
Physiotherapy I find is described very poorly. I can only assume it is magic and cannot be catagorized in any way. I would like to know if pelvic floor spasms are common, if they are more unilateral, which muscles are involved and so on. But seeing as it works by magic, it cannot be described….
I see the more localized can go for surgery – I would try botulinum first:
Vulvodynia be gone? Botox study http://painmuse.org/?p=17
while the more generalized are offered neurostimulation
They do not seem to have hear of repeated blocks recently described:
Vulvodynia or Pudental Neuralgia -Simple Repeated Injection Breakthrough Treatment
http://painmuse.org/?p=5201
They of course describe simple measures that might help – I have compiled here:
Vulvodynia Therapy Patient Resource http://painmuse.org/?p=187