The beneficial effect of short-term multimodal physiological therapy on female provoked vulvodynia: A pilot study

Abstract

ABSTRACT Introduction Vulvodynia is a subset of the genito-pelvic/penetration disorder and is currently defined by chronic pain in the vulva area of at least 3-6 months duration. It affects 8-10% of women of all ages. According to 2015 ISSVD, ISSWSH, and IPPS consensus terminology and classification of vulvodynia, it can be divided into provoked (e.g., insertional, contact), spontaneous or mixed type. Although the etiology remains an enigma, peripheral neurologic mechanism has recently been identified as a factor. Objective The aim of this trial was to evaluate the effectiveness of short-term physical therapy in women with vulvodynia. Methods Women with intolerable vulvodynia were included in the study from Jan to May 2021. Medical screen including cotton-tipped testing and pelvic examination were performed by one gynecologist. After informed consent obtained, women lied down with cross-legged receiving once treatment per 1-2 weeks until completely pain relief achieved. Treatment consisted of a multimodal approach including lidocaine gel 20mins, capsaicin gel 20mins and TENS (Transcutaneous electrical nerve stimulator) 30 mins. TENS was administered through skin probes via a dual channel NeuroTrac device. A set of double electrode patches were placed on the dermatome of unilateral side of pain: channel A constant 80Hz, and channel B burst of 9 pulses 150Hz, 175 µS pulse duration and the intensity at the maximal level that patient could tolerate. At the completion, all women were followed for 3-6 months to assess efficacy, satisfying sexual events (SSE) in 4weeks, adverse events and recurrence. Results Ten women were diagnosed with provoked (n=8) or spontaneous vulvodynia (n=2) (primary 60% and secondary 40%). The average age was 34.1 years (range= 25-50) with an average duration of vulvodynia of 50.0 months (range= 4-276). 50% of women reported tolerating intercourse sometimes, 40% never did, and one was virgin. 37.5% (n=3) underwent one treatment session, and 62.5% (n=5) two sessions to achieve completely pain relief. At the completion of one week, 100% of provoked type women reported moderate or high improvement on vulvodynia region. Those reported improvement in the frequency of SSE within 4 weeks after treatment completion (62.5% sometimes, 25% often and one didn't restart intercourse). However, both of spontaneous type women failed to treatment and were suggested a referral for nerve blocking. After 4.4-24.3 weeks follow-up, 25% of provoked group reported no recurrence, 62.5% mild recurrence, and 12.5% (n=1) moderate recurrence. Only minor adverse events occurred. 90% reported mild to moderate vulva irritation immediately after treatment, which were completely resolved after bath. Only one spontaneous type reported vulva swelling and moderate irritation for one week. 100% of participants were willing to receive treatment in the next time. Conclusions A short-term multimodal physiological therapy including lidocaine, capsaicin and TENS enabled women with provoked vulvodynia to achieve rapid pain relief, moderate or high improvement in sexual encounters and the efficacy is seemed to last long. The tolerability and safety were high. Disclosure Work supported by industry: no. A consultant, employee (part time or full time) or shareholder is among the authors (Youren clinic).