Percutaneous Tibial Nerve Stimulation (PTNS ) in Iatrogenic Chronic Vulvar Pain

Abstract

Chronic vulvar pain (CVP), although being fairly prevalent, in most cases is not attributable to a specified disorder, i.e., presents as vulvodynia. There are, however, many disorders known to cause CVP, such as radiotherapy and surgery. There have been, so far, no reports in the literature of effective treatment options for Iatrogenic CVP. Percutaneous tibial nerve stimulation (PTNS) is a neurostimulation technique used in the treatment of urinary urgency, frequency, urge incontinence, and urinary retention. There has been increasing evidence of its benefits in improving other conditions, such as chronic pelvic pain or sexual dysfunction. We report a case of a 62 year-old woman with iatrogenic chronic vulvar pain (CVP) submitted to PTNS. The patient reported a consistent and dramatic decrease in both frequency and intensity of pain, assessed by the Brief Pain Inventory (BPI). A decrease in the pain interference with mood, normal work, and walking/mobility was also noted, as evaluated by BPI and EQ-5D questionnaires. Even though a relapse of symptoms was seen after the end of the treatment protocol, it was possible to achieve more permanent benefits after a maintenance scheme of PTNS, with the patient becoming almost asymptomatic. Neuromodulation treatments have been reported as effective in cases of vulvodynia, however reports using PTNS are rare. The tibial nerve is easily accessible and provides an optimal site for neurostimulation without the need of an operating room or anesthesia. The overall improvement registered in this case of CVP elicits a new area of research for PTNS. {Need key words.} Key words: Chronic pain, pelvic pain, vulvar diseases, neuromodulation, percutaneous electric nerve stimulation, tibial nerve