(084) A Case Report of Alcohol-Induced Vestibule Pain, Resolved in the Setting of Vestibular Anesthesia Test

Abstract

Abstract Introduction Vestibulodynia is a term to denote pain in the vestibule, which encompasses the vulvar tissue beginning within the labia minora at Hart’s line to the hymen, extending anteriorly just inferior to the clitoris and to the posterior fourchette. Three subtypes of vestibulodynia exist including neuroproliferative, hormonally-mediated and inflammatory. All three subtypes can cause a constellation of symptoms including dyspareunia, dysuria, and discomfort with wearing tight clothes or wiping. Objective Described here are two patients who note pain in the vestibule within seconds of drinking alcohol. Notably, in the setting of a vestibular anesthesia test, in which the entire vestibule was completely numbed, they noticed resolution of their typical symptoms and were able to drink alcohol without vestibular pain. Methods This first patient is a 40 year old female with endometriosis, adenomyosis, PMDD, POTS, pelvic pain and 19 year history of unprovoked vestibulodynia with multiple failed treatment modalities. Upon consumption of alcohol, notices immediate pain in the vestibule. The second patient is a 27 year old female with provoked neuroproliferative vestibulodynia s/p vestibulectomy. Notes that four minutes after drinking any type of alcohol has worsening stinging and burning of the vestibule. A vestibular anesthesia test was performed, coating the vestibule in 30% Benzocaine, 8% Lidocaine and 6% Tetracaine, allowing it to sit for 10 minutes. Results Both patients drank alcohol after the 10 minutes and noted no symptoms at the tissue level whatsoever. They both still had hypertonic pelvic floors. The second patient went on to vestibulectomy and still had symptoms present, though they had decreased. Conclusions These cases indicate that alcohol may play a role in inciting vestibulodynia symptoms, and numbing of the vestibule can negate those symptoms. Possible pathophysiology may be due to the vasodilation effects of alcohol on the vestibular tissue, or a histamine response, but further research is needed to determine any potential link. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Sprout