Combination of Treatments With or Without Surgery in Localized Provoked Vulvodynia: Outcomes After Three Years of Follow-Up.

Anu Pauliina Aalto,Heini Huhtala,Johanna Mäenpää,Synnöve Staff

doi:10.1089/biores.2018.0044

Abstract

Most vulvodynia patients receive combinations of several treatment modalities for their chronic painful condition. If conservative treatments fail, vestibulectomy is considered to be the ultimate treatment option for localized provoked vulvodynia (LPV). The aim of this descriptive study was to analyze relief of pain, quality of life (QoL), and complications associated with combining surgery with conservative treatments among LPV patients, both in short term and after 3 years of follow-up.The study population consisted of a retrospective patient cohort of surgically (n = 16) and only conservatively (n = 50) treated LPV patients. QoL data were assessed by a validated questionnaire (RAND-36). Data were collected by reviewing patient records and by aid of postal questionnaires. Efficacy of treatments in relief of pain was measured by numerical rating scale (NRS). Two months after surgery, the NRS scores assessed by a physician were lower in the surgery group than in patients treated only conservatively (p = 0.008). However, after a median of 36 months of follow-up, self-reported NRS scores and QoL showed no difference between the two patient cohorts. Complication rate after vestibulectomy was 18.8%. The findings suggest that combining surgery with conservative treatments may result in a more effective short-term reduction of pain. However, the effect seemed to be only temporary, as no long-term benefit was achieved.

Highlights

Vulvodynia is a chronic pain syndrome of unknown etiology affecting 7–8% of women in populationbased epidemiological studies.1,2 Vulvodynia is usually described as burning, stabbing, itching, stinging, and feeling of irritation
All at least 18-year-old women diagnosed with vulvodynia at Tampere University Hospital (TAUH) from January 2003 to May 2016 were screened for the study
localized provoked vulvodynia (LPV) patients who fulfilled the strict criteria by Friedrich,19 or severe pain on vestibular touch or attempted vaginal entry, and tenderness on localized pressure within the vulvar vestibule, were considered eligible (n = 66)

Summary

Introduction

Vulvodynia is a chronic pain syndrome of unknown etiology affecting 7–8% of women in populationbased epidemiological studies. Vulvodynia is usually described as burning, stabbing, itching, stinging, and feeling of irritation. The 2015 Consensus and Terminology and Classification of Persistent Vulvar Pain and Vulvodynia divides vulvar pain into two categories. The first category includes vulvar pain that is caused by a specific clearly identifiable disorder (e.g., pain caused by genital herpes). The second category includes vulvar pain that is at least 3 months in duration and cannot be clearly identified or linked to a specific cause. The descriptors of the pain are location (local, generalized, and mixed), type (provoked, spontaneous, or mixed), onset (primary and secondary), and temporal pattern (intermittent, persistent, constant, immediate, and delayed). Vulvodynia may be associated with a history of yeast infection, hormonal factors, genetic factors, pelvic floor dysfunction, and psychological factors.

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