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

IF 3.1 4区 医学 Q2 DERMATOLOGY
C. Neuville , B. Parratte , S. Lombion , F. Aubin , I. Gallais Sérézal , F. Pelletier
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引用次数: 0

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.

眩晕症:一项回顾性法国队列研究中的临床特征、一线治疗方法以及与肌电图引导下注射肉毒杆菌毒素治疗升级相关的因素
背景膀胱阴道炎是一种影响外阴的高发慢性疼痛疾病,对女性的生理、心理和性健康有重大影响。目的评估前庭大腺炎女性患者一线疗法的总体疗效以及与治疗升级相关的因素。结果132名患者中,平均[标准差]诊断年龄为27.2 [±9.45]岁,平均症状持续时间为42.3 [±37.92]个月。大多数病例为诱发性(75.0%)或继发性(72.7%)前庭大腺炎。63名患者(47.7%)和23名患者(54.5%)至少合并一种疼痛或心理疾病。121名患者(91.6%)出现与盆底肌肉功能障碍相关的外阴过度收缩,94名患者(71.2%)出现外阴糜烂。85%的患者接受了带生物反馈的盆底物理治疗,36%的患者接受了阿米替林治疗,17%的患者接受了额外的利多卡因乳膏治疗。52名患者(39%)对一线治疗至少有良好反应,只有21名患者(15%)完全缓解,与治疗策略无关(P = 0.25)。54名患者接受了肉毒杆菌毒素注射。原发性前庭神经痛(p = 0.04)或自发性前庭神经痛(p = 0.03)的患者更有可能接受这种治疗。考虑到肌肉功能障碍的高发病率,肉毒杆菌毒素注射尤其值得关注,尽管在这一适应症方面缺乏随机对照试验。
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来源期刊
CiteScore
1.40
自引率
0.00%
发文量
70
审稿时长
81 days
期刊介绍: Les Annales de dermatologie sont le rendez-vous mensuel incontournable de toute la dermatologie francophone, grâce à leur comité de rédaction qui assure une sélection rigoureuse des articles selon les normes de l''édition scientifique internationale. Une revue didactique, véritable aide à la pratique médicale quotidienne Pour compléter et enrichir la partie scientifique, la rubrique Formation médicale continue propose aux lecteurs des textes didactiques et interactifs (Cas pour diagnostic, Notes de pharmacovigilance, la Question du praticien, Dermatologie chirurgicale, la Sélection bibliographique du mois...) qui les font bénéficier d''une formation post-universitaire diversifiée et de qualité. La revue consacre également un espace pour la publication de questions des lecteurs auxquelles des experts apportent une réponse.
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