Therapy With Local Anesthetics to Treat Vulvodynia. A Pilot Study

Stefan Weinschenk; Justus Benrath; Eugen Kessler; Thomas Strowitzki; Manuel Feisst

doi:10.1016/j.esxm.2021.100482

Therapy With Local Anesthetics to Treat Vulvodynia. A Pilot Study

Sex Med. 2022 Apr;10(2):100482. doi: 10.1016/j.esxm.2021.100482. Epub 2022 Jan 18.

Authors

Stefan Weinschenk¹, Justus Benrath², Eugen Kessler³, Thomas Strowitzki⁴, Manuel Feisst⁵

Affiliations

¹ Outpatient practice Weinschenk & Scherer, Karlsruhe, Germany; Deprtment of Gynecological Endocrinology and Fertility Disorders, Women's Hospital, Heidelberg University, Germany; the Heidelberg University Neural Therapy Education and Research (HUNTER) Group (www.hunter-heidelberg.com. Electronic address: stefan.weinschenk@med.uni-heidelberg.de.
² Clinic of Anesthesiology and Intensive Care, Pain Centre, University Clinic, Mannheim, Germany; the Heidelberg University Neural Therapy Education and Research (HUNTER) Group (www.hunter-heidelberg.com.
³ Medical School, Heidelberg University, Germany.
⁴ Deprtment of Gynecological Endocrinology and Fertility Disorders, Women's Hospital, Heidelberg University, Germany.
⁵ Institute of Medical Biometry and Informatics; Heidelberg University, Heidelberg, Germany; the Heidelberg University Neural Therapy Education and Research (HUNTER) Group (www.hunter-heidelberg.com.

Abstract

Introduction: Vulvodynia (chronic vulvar pain) is a sexually debilitating disorder with a prevalence of ∼10%.

Aim: To investigate the effectiveness of therapy with local anesthetics (TLA) in women with severe vulvodynia, we conducted a prospective, non-controlled observational study.

Methods: 45 patients with severe chronic vulvodynia (primary and secondary vulvodynia, 0-10 numeric analogue scale (NAS) ≥6, median 7.9, duration ≥6 months, median 65.2 months) in an outpatient practice in Germany were treated with TLA in 3-12 sessions using procaine 1% as local anesthetic. Effectiveness was analyzed with Wilcoxon signed rank tests and Wilcoxon rank sum tests.

Outcomes: Therapeutic success as a reduction of pain to ≤4 NAS lasting for ≥6 months after end of therapy.

Results: TLA successfully reduced vulvodynia in 36 of 45 patients (80 %, responders). The NAS reduction was from 7.9 to 2.4 (P < .001). Even patients denominated as non-responders experienced a significant reduction in NAS (P = .03). In responders, long-term success was observed for 6.8-125 months (median 24.1 months). No adverse events occurred.

Clinical translation: A promising new treatment for a hard-to-treat chronic female pain disorder.

Strengths and limitations: Limitation: Monocentric, non-controlled observational design; Strength: the high number of patients treated.

Conclusion: The high success rate of TLA in this investigation offers new perspectives on the etiology of vulvodynia as a complex pain syndrome affecting several nerves of the pelvic floor, and also provides early insight into the effectiveness of TLA in women with vulvodynia. Weinschenk S, Benrath J, Kessler E, et al. Therapy With Local Anesthetics to Treat Vulvodynia. A Pilot Study. Sex Med 2022;10:100482.

Keywords: Complex Pain Syndrome; Neural Therapy; Neurogenic Inflammation; Pudendal Neuralgia; Vestibulitis; Vulvar Pain.