Neuropathic pain in vulvar vestibulitis: Diagnosis and treatment

Patients affected by vulvar vestibulitis syndrome (VVS) suffer from symptoms typical of neuropathic pain such as allodynia and hyperalgesia. Because of the severe pain on vestibular touch or attempt- ed vaginal entry, intercourse is increasingly avoided. Pathophysiology of physical symptoms is related to the microscopic findings of prolifera- tion of pain fibers which are also superficialized within the vestibular tissue. Current non-invasive treatment may be useful in a number of patients, but the most severe cases need a stronger approach, such as anaesthetic nervous blocks. Monthly repeated nervous anaesthetic blocks with bupivacaine of the impar ganglion, sacral roots and puden- dal nerves, completed by ancillary therapy including antidepressant and anticonvulsant (as gabapentin) drugs, may progressively reduce intensity of pain and its extension. Both decreased ending fibers sprout- ing induced by periodic anaesthetic blocks sessions and secondary changes of forebrain activity seem to be a rational pathophysiologic ex- planation of the efficacy of this new and original therapy for VVS' pain. Urodinamica 14: 112-116, 2004 © 2004, Editrice Kurtis