Therapy With Local Anesthetics to Treat Vulvodynia. A Pilot Study

Abstract

Abstract Introduction Vulvodynia (chronic vulvar pain) is a sexually debilitating disorder with a prevalence of ∼10%. Aim To investigate the effectiveness of therapy with local anesthetics (TLA) in women with severe vulvodynia, we conducted a prospective, non-controlled observational study. Methods 45 patients with severe chronic vulvodynia (primary and secondary vulvodynia, 0–10 numeric analogue scale (NAS) ≥6, median 7.9, duration ≥6 months, median 65.2 months) in an outpatient practice in Germany were treated with TLA in 3–12 sessions using procaine 1% as local anesthetic. Effectiveness was analyzed with Wilcoxon signed rank tests and Wilcoxon rank sum tests. Outcomes Therapeutic success as a reduction of pain to ≤4 NAS lasting for ≥6 months after end of therapy. Results TLA successfully reduced vulvodynia in 36 of 45 patients (80 %, responders). The NAS reduction was from 7.9 to 2.4 (P < .001). Even patients denominated as non-responders experienced a significant reduction in NAS (P = .03). In responders, long-term success was observed for 6.8–125 months (median 24.1 months). No adverse events occurred. Clinical Translation A promising new treatment for a hard-to-treat chronic female pain disorder. Strengths and Limitations Limitation: Monocentric, non-controlled observational design; Strength: the high number of patients treated. Conclusion The high success rate of TLA in this investigation offers new perspectives on the etiology of vulvodynia as a complex pain syndrome affecting several nerves of the pelvic floor, and also provides early insight into the effectiveness of TLA in women with vulvodynia.