Vulvodynia and Chronic Vulvar Pain: Influencing Factors and Long-Term Success After Therapeutic Local Anesthesia (TLA).

Abstract

Introduction: Vulvodynia is a debilitating sexual disorder with a high prevalence of 7-11%. In the study reported here, we analyzed long-term results from a prospective, non-controlled observational study to enhance our understanding of the success of therapeutic local anesthesia (TLA) and to investigate factors that predict a response or failure of therapy, with the overall aim to gain new insights into the complex medical condition of vulvodynia.

Methods: A total of 45 patients diagnosed with severe chronic vulvodynia or chronic vulvar pain (Numeric Analog Scale [NAS] ≥ 6, median 7.9, duration ≥ 6 months, median 65.2 months) and previously treated with TLA were re-evaluated 4.5-13 years after therapy. Therapy response was defined as NAS ≤ 4 for at least 6 months.

Results: Of the 45 patients originally diagnosed with vulvodynia, 38 were available for follow-up (32 of the original 36 responders, and 4 of the 9 non-responders). The average follow-up period was 7.9 years (95.2 months, range 55-156 months) after the end of therapy. All responders remained symptom-free, and two of the non-responders also became responders. Factors associated with non-response were: the number of physicians seen previously, lichen sclerosus, previous traumata, relapses of recurrent cystitis, corticoid therapy, and psychological factors, including depression, psychotropic drug intake, and psychotherapy. Body mass index (BMI) was lower in non-responders. The number of deliveries, cesarean sections, abortions, age, hormonal status, other medication intake, and gynecological surgeries had no impact on the results.

Conclusion: The long-term success of TLA supports the hypothesis that neuralgia of one or more nerves of the pelvic floor is an important component in the development of vulvodynia. This study provides evidence for the long-term effectiveness of TLA in women with vulvodynia, as well as potential obstacles to healing. Despite limitations imposed by a monocentric, non-controlled observational design, the robustness of this investigation lies in the long observation period after treatment and the substantial percentage of patients for whom TLA was successful. The long-term results emphasize the necessity of a holistic approach integrating the view of vulvodynia as a peripheral neuro-functional disorder.