Vulvar Dysesthesia: New Treatments for a Real Therapeutic Challenge

The syndrome of chronic vulvar pain, which is traditionally referred to as vulvodynia, but is nowadays called either local or general vulvar dysesthesia, continues to be enigmatic for doctors involved in its diagnosis and treatment. Most patients suffering from local dysesthesia or vestibulitis have undergone multiple local or systemic treatments, generally unsuccessfully, which makes them visit various gynaecologists, dermatologists and even psychiatrists. Pain combined with the repeated therapeutic failures provoke a feeling of frustration and abandonment which end up with personal repercussions in the life of the patient and his relationship with his partner. This, combined with the conviction of the patient that no ideal treatment exists, converts this affection into a therapeutic challenge for the doctor who tries to treat it.

We present the results obtained for 5 patients diagnosed of local vulvar dysesthesia or vestibulitis, previously unsuccessfully treated with combined therapies, who favourably responded to repeated injections of Botulinum toxin A (Vistabel®, Allegran, Europe). The dose ranged between 24 and 48 U, administered every 90 days in the case of persistence of the symptoms. The main visual analogue pain score was 3.4 after the 1st dose of the Botulinum toxin A; it was 9.8 before the treatment. None of the patients had recurrence during the one to two years and a half, average 17 months, follow-up period. Botulinum toxin A is effective in blocking nociception. It is a safe and effective therapy for the treatment of vulvar dysesthesia of muscular or neuroinflammatory origin.