Vestibulodynia: Clinical characteristics, first-line treatments, and factors associated with escalation of treatment with EMG-guided injections of botulinum toxin in a retrospective french cohort study

C Neuville; B Parratte; S Lombion; F Aubin; I Gallais Sérézal; F Pelletier

doi:10.1016/j.annder.2024.103277

Vestibulodynia: Clinical characteristics, first-line treatments, and factors associated with escalation of treatment with EMG-guided injections of botulinum toxin in a retrospective french cohort study

Ann Dermatol Venereol. 2024 Apr 27;151(2):103277. doi: 10.1016/j.annder.2024.103277. Online ahead of print.

Authors

C Neuville¹, B Parratte², S Lombion³, F Aubin⁴, I Gallais Sérézal⁴, F Pelletier⁵

Affiliations

¹ Department of Dermatology, University Hospital, Besançon, France.
² University Franche-Comté, Besançon, France.
³ SLC Expertise Founder, Besançon, France.
⁴ Department of Dermatology, University Hospital, Besançon, France; INSERM UMR 1098 RIGHT, University of Besançon, Besançon, France.
⁵ Department of Dermatology, University Hospital, Besançon, France; INSERM UMR 1098 RIGHT, University of Besançon, Besançon, France. Electronic address: fpelletier@chu-besancon.fr.

PMID: 38678773
DOI: 10.1016/j.annder.2024.103277

Abstract

Background: Vestibulodynia is a highly prevalent chronic pain disorder affecting the vulva having a major impact on women's physical, psychological, and sexual well-being. It remains an underrecognized disease that responds insufficiently to therapies such as physiotherapy and medication.

Aim: To assess the global efficacy of first-line therapies and factors associated with treatment escalation in women with vestibulodynia.

Patients and methods: This retrospective cohort study was conducted at the dermatology outpatient clinic of the University Hospital in Besancon (France) between 2013 and 2017 and follow-up until 2021.

Results: Among 132 patients, the mean [standard deviation] age at diagnosis was 27.2 [±9.45] years, with an average duration of symptoms of 42.3 [±37.92] months. Most cases comprised provoked (75.0%) or secondary (72.7%) vestibulodynia. At least one comorbid pain or psychologic condition was identified respectively in 63 (47.7%) and 23 patients (54.5%). Vulvar hyperesthesia associated with pelvic floor muscle dysfunction was present in 121 patients (91.6%) and vulvar erethism was noted in 94 patients (71.2%). First-line treatments consisted of pelvic floor physiotherapy with biofeedback in 85% of patients, associated with amitriptyline in 36% of cases, and of additional lidocaine cream in 17%. Fifty-two patients (39%) presented at least a good response to first-line treatment, with only 21 (15%) being in complete remission, irrespective of therapeutic strategy (p = 0.25). Botulinum toxin injections were performed in 54 patients. Patients with either primary vestibulodynia (p = 0.04) or spontaneous vestibulodynia (p = 0.03) were more likely to receive this treatment.

Conclusion: Our study highlights the current lack of efficacy of first-line treatments in vestibulodynia. Considering the high prevalence of muscular dysfunction, botulinum toxin injections are of particular interest despite a lack of randomized controlled trials in this indication.

Keywords: Vestibulodynia; Women's health; botulinum toxin type A.