Unilateral Vulvodynia Caused by Myofascial Pain Syndrome of Adductors-A Case Report

Abstract

Tenderness and pain over the genital region may be due to enormous causes, but few are diagnosed as myofascial pain syndromes in origin. Here we presented a case of unilateral vulvodynia diagnosed as a myofascial pain syndrome was successfully treated by trigger point injections. A 22 year-old female suffered from acute right genital pain after a spontaneous delivery whenever intercourse or some sitting position. She visited gynecologists and negative pelvic examinations were told. Meanwhile, she received multi medical treatments about ten months but in vain. She was referred to our pain clinic for further treatment. Tracing back to her delivery history, the baby's weight was 4100gm and shoulder dystocia was told. Physical examination revealed tenderness and pain over the region of right adductor magnus, adductor longus with trigger points and genital region. Symptoms and signs were exacerbated while abduction of right thigh. A myofascial pain syndrome of adductors referring to genital region was highly suspected, which was related to McRoberts maneuver during a spontaneous delivery. This maneuver might overstretch these muscles and develop muscular trauma. Tenderness and pain over the genital region was improved after the first trigger point injections. The second injections were performed one week later, and then symptoms and signs were fully subsided. Therefore, we suggested that palpating trigger points should be as part of physical examinations for unusual pelvic and genital pain. Trigger point injections can provide an easy and effective method in the diagnosis and treatment of vulvodynia caused by myofascial pain of adductors.