Pain Medical Musing

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.

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