Treatment of Vulvar Vestibulitis with Submucous Infiltrations of Methylprednisolone and Lidocaine

J Reprod Med 2001;46:713–6 This group from Italy gave subcutaneous injections of 40 mg of methylprednisolone acetate and 10 mg of lidocaine cloridrate in 10 ml of normal saline into the vulvar vestibule in 22 women with vulvar vestibulitis. Injections were divided into equal parts between three sites, described as 4 o'clock, 8 o'clock, and around the posterior fourchette. Follow up occurred monthly for three months, then after six and nine months. Fourteen women had 12 months and five women 24 months of follow up. Fifteen women (68%) responded “favorably” to treatment, 32% with complete remission. Remission of symptoms occurred about 15 days after treatment. Five patients relapsed after one year and responded with immediate remission when treated with a 0.5 ml infiltration. None required therapy after the 12th month. Comment: Vulvar vestibulitis syndrome is difficult for patients and practitioners with a myriad of treatments including oceans of lotions and potions and notions about what should make this go away. Long-term antifungal therapies, steroid creams, sex hormone creams, topical analgesics, diets, dietary supplements, capsacin, laser, antidepressants, anticonvulsants, musculoskeletal therapies, surgeries of various kinds, and many other things have been tried as treatments. This extended case report suggests a possible therapy that would be readily available, but one really wonders if it is any different than any of these other partially successful therapies. (TMJ)