ABSTRACT
Abstract Background: Vulvar diseases are common in the general population and have a negative impact on the quality of life. Objectives: To describe our experience as dermatologists in the management of vulvar dermatosis consultations. Methods: A retrospective observational study was conducted with patients who attended monographic vulvar consultations over a 5-year period. Clinical information was obtained from the patient's charts. Results: 148 women were studied. Their mean age was 43.24 years (standard deviation: 15.15 years), with ages ranging from 4 months to 80 years. 53.4% of patients took between 2 and 5 years to seek medical attention for the first time. The most frequent diagnosis was lichen sclerosus (41.9%), irritative eczema of the vulva (14.9%), and lichen simplex chronicus (10.1%). 83.8% reported anogenital itching, 66.2% pain, and 45.9% dyspareunia. The most frequently prescribed treatment was ultra-potent topical corticosteroids (clobetasol propionate; 41.2%). Patients with lichen sclerosus were significantly older than those who presented with any of the other diseases. No differences were found in terms of either the time of disease evolution or in symptom presentation. Study limitations: Retrospective study. Vulvar diseases with an infectious cause are usually managed in primary care, therefore, were not included. All patients were recruited from a single private hospital which limits the comparisons with the public health system. Conclusions: Vulvar diseases frequently occur and are associated with high morbidity. It is essential to promote the development of specific vulvar consultations in hospitals. Specialties such as dermatology, gynecology, urology, or physiotherapy must be part of these units.
ABSTRACT
We report 4 cases of vulvodynia, vulval pain from unknown causes that showed symptomatic improvements by administrating Kampo medicines. Modern medicines, such as analgesics, treatments for endometriosis or hormone replacement therapy, can't always be effective for vulvodynia and not a few patients go to see different hospitals without improving their pain. We diagnosed these 4 cases of vulvodynia were originated in kekkyo. We administered Kampo medicines, mainly shimotsuto with supporting ones, and the symptoms of vulvodynia improved.
ABSTRACT
Objetivo: Verificar a eficácia da TENS no tratamento de mulheres com vulvodínia localizada provocada. Métodos: Buscou-se, nas bases de dados SciELO, PEDro e PubMed, por estudos que utilizaram a TENS como tratamento da vulvodínia localizada provocada. Resultados: Dos 50 artigos recuperados, três foram analisados: dois ECRs e um estudo de coorte longitudinal não controlado. Conclusão: A TENS pode ser eficaz como uma opção de tratamento na melhora da dor vulvar, sendo uma opção de baixo custo, não invasivo e de fácil manejo; assim como outras terapias combinadas, parece ter um efeito positivo e benéfico no tratamento da vulvodínia localizada provocada. (AU)
Objective: To verify the efficacy of TENS in the treatment of women with localized provoked vulvodynia. Methods: Searched the databases SciELO, PEDro, PubMed, for studies that used TENS as a treatment of localized vulvodynia. Results: Of the 50 articles retrieved, 3 articles were analyzed: 2 RCTs, 1 uncontrolled longitudinal cohort study. Conclusion: The TENS can be effective as a treatment option in improving vulvar pain and is a low-cost, non-invasive and easy to use option, as well as other combined therapies, which appears to have a positive and beneficial effect in the treatment of localized provoked vulvodynia.(AU)
Subject(s)
Humans , Female , Transcutaneous Electric Nerve Stimulation/instrumentation , Transcutaneous Electric Nerve Stimulation/methods , Vulvodynia/therapy , Pain Measurement , Databases, Bibliographic , Pelvic Pain/therapy , Dyspareunia/therapyABSTRACT
Vulvodynia is defined as vulvar pain of at least three months duration without a clearly identifiable cause. Currently, there are few established treatments. We report two cases of vulvodynia treated successfully with relief of insomnia, using Japanese herbal medicine including saiko. Case 1: A 29-year-old female had been in a poor physical condition for two years. Initially, she had vulvar itching, which gradually became vulvar pain. At the first consultation, she complained of not only vulvar pain but also insomnia and feeling cold. Additional symptoms included severe fatigue, constipation, frustration, stiff shoulder, and heart palpitations. There were no abnormal findings in the genital region. We began treating the insomnia and coldness using saikokeishikankyoto. By the time of the second consultation two weeks later, her insomnia and coldness completely resolved, vulvar pain disappeared, and other symptoms improved. Case 2: A 46-year-old female experienced vulvar pain two months before the first visit to the hospital. The pain increased gradually and she awakened every 30 minutes in the night with severe vulvar pain. However, there were no abnormal findings in the genital region. We used saikokaryukotsuboreito, an antidepressant and a sleeping pill. Her insomnia improved gradually, and vulvodynia resolved two weeks after the improvement of the insomnia. These results suggest that saiko is effective on vulvodynia with insomnia.
ABSTRACT
Abstract Genito-pelvic pain/penetration disorder (GPPPD) can be an extremely bothersome condition for patients, and a tough challenge for professionals regarding its assessment and treatment. The goal of the present paper is to review the etiology, assessment, and treatment of GPPPD, especially focusing on the cognitive aspects of the disease and cognitive-behavioral treatment options, through a non-systematic review of articles indexed to the Medline, Scopus and Web of Science databases, using the following MeSH queries: pelvic pain; dyspareunia; vaginismus; vulvodynia; and cognitive therapy. Altogether, 36 articles discussing the etiology, diagnosis and management of GPPPD were selected. We provide an overview of GPPPD based on biological, psychological and relational factors, emphasizing the last two. We also summarize the available medical treatments and provide strategies to approach the psychological trigger and persisting factors for the patient and the partner. Professionals should be familiarized with the factors underlining the problem, and should be able to provide helpful suggestions to guide the couple out of the GPPPD fear-avoidance circle.
Resumo A perturbação de dor gênito-pélvica e da penetração (PDGPP) é uma patologia com elevado impacto no bem-estar das pacientes, e traduz-se num desafio diagnóstico e de tratamento para os profissionais que as acompanham. O objetivo deste artigo é rever a etiologia e o tratamento da PDGPP, tendo em conta, principalmente, os aspetos cognitivos e as abordagens de inspiração psicoterapêutica cognitivo-comportamental. Para tal, foi efetuada uma revisão não sistemática dos artigos indexados às bases de dados Medline, Scopus e Web of Science, usando os termos: dor pélvica; dispareunia; vaginismo; vulvodinia; e terapia cognitiva. No total, foram incluídos 36 artigos discutindo a etiologia, diagnóstico e tratamento da PDGPP. Neste artigo, proporcionamos uma revisão do tratamento da PDGPP baseado em fatores biológicos, psicológicos e relacionais, enfatizando os últimos dois. Também resumimos as opções de tratamento
Subject(s)
Humans , Female , Pelvic Pain/diagnosis , Pelvic Pain/etiology , Pelvic Pain/therapy , Dyspareunia/diagnosis , Dyspareunia/etiology , Dyspareunia/therapy , Vaginismus/diagnosis , Vaginismus/etiology , Vaginismus/therapy , Vulvodynia/diagnosis , Vulvodynia/etiology , Vulvodynia/therapyABSTRACT
La vulvodinia es definida como un malestar vulvar, descrito como un dolor tipo ardor con una duración promedio de 3 meses y con una prevalencia de 16%. La metodología empleada consistió de una revisión y análisis sistemático en bases de datos electrónicos, mediante el uso de palabras clave. Su etiología sigue siendo desconocida, a pesar de que diversas teorías sostienen que tiene un origen multifactorial. El diagnóstico de la vulvodinia se realiza mediante una evaluación minuciosa de la historia del dolor, historia sexual, situación clínica y examen físico. El tratamiento no médico incluye intervenciones psicológicas, que tienen por objetivo disminuir el dolor y restaurar la función sexual. Las terapias alternativas aún no han demostrado su eficacia para el tratamiento de la vulvodinia, mientras que la terapia física, al disminuir las restricciones tisulares, ayudan a restaurar la longitud de los músculos y tejidos de la pelvis. Asimismo, el tratamiento médico incluye terapia local mediante el uso de antinociceptivos y agentes antiinflamatorios, neuromoduladores; también se utiliza antidepresivos tricíclicos, norepinefrina y anticonvulsivos. El tratamiento quirúrgico ha demostrado ser una estrategia que permite disminuir el dolor siendo de importancia destacar la experiencia del cirujano como un factor determinante. En conclusión, la vulvodinia es un problema de salud para la mujer, que afecta su función sexual y calidad de vida. El tratamiento debe ser abordado con un enfoque holístico y multidisciplinario.
Vulvodynia is defined as vulvar discomfort, described as a burning pain with an average duration of 3 months and a prevalence of 16%. The methodology used consisted of a systematic review and analysis in electronic databases, through the use of keywords. The etiology remains unknown, despite the fact that various theories maintain that it has a multifactorial origin. The diagnosis of vulvodynia is made through a thorough evaluation of the history of pain, sexual history, clinical situation and physical examination. Non-medical treatment includes psychological interventions that aim to reduce pain and restore sexual function. Alternative therapies have not yet proven effective for the treatment of vulvodynia, while physical therapy, by helping to reduce tissue restrictions, helps restore the length of the muscles and tissues of the pelvis. Likewise, medical treatment includes local therapy, through the use of antinociceptives, anti-inflammatory agents and neuromodulators; It also uses tricyclic antidepressants, norepinephrine and anticonvulsants. Surgical treatment has been shown to be a strategy to reduce pain and the surgeon's experience should be taken into account as a determining factor. In conclusion, vulvodynia is a health problem for women that affects their sexual function, quality of life and treatment must be approached with a holistic and multidisciplinary approach.
ABSTRACT
<p><b>BACKGROUND</b>Vulvodynia, or vulvar pain, is a common condition in women; however, there are few evidence-based clinical trials evaluating nonpharmacological therapies for this condition. Acupuncture is one complementary and integrative medicine therapy used by some patients with vulvodynia. This study evaluates two different acupuncture strategies for the treatment of vulvodynia and aims to evaluate whether either of the acupuncture protocols reduces vulvar pain, pain duration or pain with intercourse. The study also examines how long the effect of acupuncture lasts in women with vulvodynia.</p><p><b>METHODS/DESIGN</b>The study is designed as a randomized controlled trial, focused on two acupuncture protocols. Fifty-one patients who have had vulvodynia for more than 3 months will be recruited. Among them, 34 patients will be randomized into Groups 1a and 1b; those who are unwilling to receive acupuncture will be recruited into the standard care group (Group 2). Patients in Group 1a will have acupuncture focused on the points in the pudendal nerve distribution area, while patients in Group 1b will receive acupuncture focused on traditional (distal) meridian points. Patients in Group 2 will receive routine conventional treatments, such as using pain medications, local injections and physical therapies or other nonsurgical procedures. Acupuncture will last 45 min per session, once or twice a week for 6 weeks. The primary outcome measurement will be objective pain intensity, using the cotton swab test. The secondary outcome measurement will be subjective patient self-reported pain intensity, which will be conducted before cotton swab test. Pain intensities will be measured by an 11-point Numeric Pain Rating Scale. Pain duration and pain score during intercourse are recorded. Local muscle tension, tenderness and trigger points (Ashi points) are also recorded. All measurements will be recorded at baseline (before the treatment), at the end of each week during treatment and at the end of the 6 weeks. Follow-up will be done 6 weeks following the last treatment.</p><p><b>DISCUSSION</b>Results of this trial will provide preliminary data on whether acupuncture provides better outcomes than nonacupuncture treatments, i.e., standard care, and whether acupuncture focused on the points in pudendal nerve distribution, near the pain area, has better results than traditional acupuncture focused on distal meridian points for vulvodynia.</p><p><b>TRIAL REGISTRATION</b>Clinicaltrials.gov: NCT03481621. Register: March 29, 2018.</p>
ABSTRACT
Adjuvant radiation therapy (RT) after colorectal cancer surgery can prevent local recurrence, but has several side effects. Precise injection of drugs into the affected areas is complicated by radiation-induced fibrosis of soft or connective tissue. A 48-year-old woman experienced severe intractable perineal pain, dysuria, urinary urgency, and frequent urination after rectal cancer surgery and adjuvant RT, and was diagnosed with radiation-induced cystitis and vulvodynia. Her symptoms persisted despite two fluoroscopy-guided ganglion impar blocks. Fluoroscopy revealed atypical needle tip positioning and radiolucent dye distribution, presumably due to radiation-induced fibrosis in the target region. We performed two computed tomography (CT)-guided ganglion impar blocks by using a lateral approach, which allowed more accurate po-sitioning of the needle tip. Her pain visual analog score decreased from 9 to 3, and she recently resumed sexual intimacy. CT guidance is a viable alternative to fluoroscopy guidance when performing ganglion impar blocks in fibrotic areas.
Subject(s)
Female , Humans , Middle Aged , Colorectal Neoplasms , Connective Tissue , Cystitis , Dysuria , Fibrosis , Fluoroscopy , Ganglia, Sympathetic , Ganglion Cysts , Needles , Nerve Block , Radiotherapy , Rectal Neoplasms , Recurrence , Urination , VulvodyniaABSTRACT
A Vulvodínia Localizada Provocada (VLP) é um tipo de dor crônica limitante e de interesse clínico, cuja etiologia ainda é obscura e para a qual parece não haver consenso a respeito da terapêutica. O objetivo desta pesquisa foi descrever o papel da fisioterapia pélvica no tratamento da VLP. Para tanto, foi realizada uma Revisão sistemática das bases de dados PubMed, LILACS, PEDro e SciELO a partir das palavras-chave vulvodínia, vestibulodínia e dor vulvar, bem como suas variáveis em inglês, em busca de ensaios clínicos que tratassem de técnicas fisioterapêuticas para esse fim. Foram incluídos ensaios clínicos e estudos observacionais e excluídos os que tratassem de estudos em homens ou cobaias e os que versavam unicamente de tratamento cirúrgico ou medicamentoso. Todos foram analisados e qualificados pelos graus de evidência da Associação Médica Brasileira (AMB). Os resultados mostraram que de um um total de 14 artigos, quatro foram estudos de caso, cinco, ensaios randomizados controlados e os demais, estudos observacionais de coorte, transversais e retrospectivos. Foram descritos tratamentos por eletroestimulação, terapia comportamental e fisioterapia pélvica focada nos exercícios do assoalho pélvico, particularmente de propriocepção e coordenação motora visando à recuperação da capacidade ativa de relaxamento. Houve forte evidência suportando a eficácia da fisioterapia pélvica no alívio do quadro clínico da VLP. Não houve consenso a respeito de qual técnica, dentro do arsenal fisioterapêutico, é a mais eficiente para essas pacientes. Concluiu-se que a fisioterapia pélvica é segura e eficiente no tratamento da VLP e deve encabeçar o algoritmo terapêutico desse tipo de paciente.(AU)
Localized Provoked Vulvodynia (LPV) is a limiting chronic pain of clinical interest, whose etiology is still unclear and for which there is no consensus on the therapy. The aim of this paper was to describe the role of pelvic physiotherapy in the treatment of VLP. It was necessary a systematic review of databases PubMed, LILACS, PEDro and SciELO with the keywords vulvodynia, vestibulodínia and vulvar pain in Portuguese and in English, searching for clinical trials upon the physical therapy techniques for this purpose. It was included clinical trials and excluded those that concerned men or mice or only surgical or drug treatment. All of them were analyzed and qualified by the Associação Médica Brasileira (AMB) evidence scale. The results showed that on a total of 14 articles, four were case reports, five, randomized controlled trials, and the others, retrospective study and cross-sectional study studies. They described electrical stimulation treatments, behavioral therapy and pelvic physical therapy focused on pelvic floor exercises, particularly of proprioception and coordination aimed the recovery of active capacity of relaxation. There was strong evidence supporting the effectiveness of pelvic physiotherapy in relieving the clinical symptoms of LPV. There was no consensus about which technique on the physical therapy arsenal is the most effective. Concludes that pelvic physical therapy is safe and effective in the treatment of LPV, and should be considered as first line therapeutic in the algorithm of this kind of patient.(AU)
Subject(s)
Humans , Female , Physical Therapy Modalities , Pelvic Floor/physiopathology , Vulvodynia/therapy , Chronic Pain/therapy , Behavior Therapy/methods , Electric Stimulation Therapy/methods , Databases, Bibliographic , Exercise Therapy/methods , Pulsed Radiofrequency Treatment/methods , Hyperthermia, Induced/methodsABSTRACT
A vulvodínia é uma condição de desconforto vulvar crônico que afeta milhares de mulheres a cada ano. Trata-se de síndrome multifatorial com grande impacto na qualidade de vida das mulheres afetadas. Seu tratamento representa atualmente um desafio para o médico assistente que, apesar de estar mais atento ao seu diagnóstico, ainda não encontra evidências científicas para tratamento dessas pacientes. Ainda não é possível encontrar revisões sistemáticas ou metanálises pela heterogeneidade dos artigos. A abordagem multidisciplinar parece trazer melhores resultados. Habitualmente essas mulheres passam por vários especialistas à procura de alívio dos seus sintomas, na maioria das vezes sem sucesso. Este artigo objetiva fazer uma revisão atualizada do diagnóstico e tratamento da vulvodínia para orientar a prática clínica.(AU)
Vulvodynia is a vulvar discomfort and chronic condition that affects millions of women each year. It is a multifactorial syndrome with great impact on the quality of life of women affected by it. Its treatment is currently a challenge for the physician. Despite being closer to the diagnosis, scientific evidence for treating these patients has not yet been found. Systematic reviews and meta-analysis cannot be found due to the heterogeneity of the articles. A multidisciplinary approach seems to bring the best results. Usually these women consult several specialists seeking relief of their symptoms, most of the time without success. The aim of this article is to review the current diagnosis and treatment of vulvodynia to guide clinical practice.(AU)
Subject(s)
Female , Vulvodynia/classification , Vulvodynia/diagnosis , Vulvodynia/drug therapy , Vulvodynia/therapy , Pruritus Vulvae , Risk Factors , Databases, Bibliographic , Vulvar VestibulitisABSTRACT
PURPOSE: Vulvodynia is characterized by chronic vulvar pain caused by sexual intercourse and often results in female sexual dysfunction. Because the causes of vulvodynia are not clear, many patients do not receive optimal treatment. Recently, gabapentin and botulinum toxin A have both been shown to be effective treatments for vulvodynia. In this study, we retrospectively analyzed the clinical outcomes of botulinum toxin A and gabapentin treatment for chronic pain in women with this condition. MATERIALS AND METHODS: Seventy-three women with vulvar pain were administered either gabapentin (n=62) or botulinum toxin A (n=11) injections. Effectiveness was measured by use of a visual analogue scale (VAS). We analyzed the treatment method, treatment duration, success of treatment, and side effects or adverse reactions. RESULTS: Pain levels in both groups significantly decreased after treatment. In the gabapentin group, the VAS score decreased from 8.6 before treatment to 3.2 after treatment (p<0.001). The VAS score in the botulinum toxin A group was reduced from 8.1 to 2.5 (p<0.001). Side effects for both therapies were few and subsided with treatment with general antibiotics and nonsteroidal antiinflammatory drugs. CONCLUSIONS: Gabapentin and botulinum toxin A are safe and effective treatments for vulvodynia. This condition can cause sexual dysfunction and affect quality of life. However, with proper management, satisfactory outcomes for women with vulvodynia can be achieved.
Subject(s)
Female , Humans , Amines , Anti-Bacterial Agents , Botulinum Toxins , Chronic Pain , Coitus , Cyclohexanecarboxylic Acids , Dyspareunia , gamma-Aminobutyric Acid , Quality of Life , Retrospective Studies , VulvodyniaABSTRACT
Vulvodynia is a chronic pain syndrome in female genitalia in the absence of visible infectious, inflammatory, or neoplastic findings or a clinically identifiable neurological disorder. We report a case of vulvodynia successfully treated with dry needling using a specially designed round needle (Ahn's needle). A 50-year-old woman was seen with 20-year-history of left-sided vulvar pain in the absence of infectious, inflammatory, neoplastic, or neurological disorder. We diagnosed her condition as vulvodynia and conducted dry needling using an Ahn's needle. Dry needling was performed along left upper and middle labiocrural fold. She reported 50% improvement of vulvodynia after the first treatment and 100% improvement after the second treatment. She remained symptom free 9 months after treatment. Our report suggests that dry needling using an Ahn's needle have clinical significance in managing vulvodynia.
Subject(s)
Female , Humans , Middle Aged , Chronic Pain , Genitalia , Genitalia, Female , Needles , Nervous System Diseases , VulvodyniaABSTRACT
La vulvodinia es una patología compleja y de difícil tratamiento. Se define como un dolor crónico de la vulva, que puede ser generalizado o localizado. La primera vez que se escribe sobre esta fue en 1889, por Skene. Sin embargo, es sólo hasta 1976, que los miembros de la International Society for Study of Vulvovaginal Diseases, reconocieron el dolor vulvar como una entidad patológica. Se estima una prevalencia de un 15 por ciento, con unas 14 millones de mujeres que lo padecen en EEUU. Generalmente consultan múltiples veces y a diferentes médicos, antes de llegar a un diagnóstico. No existen pruebas específicas, por lo que la clínica y el examen físico son las principales herramientas. Se deben excluir todas aquellas patologías que explican este dolor crónico vulvar. Su etiología es multifactorial, involucrando cambios a nivel de nociceptores, alteraciones de la inervación y la presencia de factores inflamatorios. Sin embargo, no podemos dejar de lado los aspectos psicosexuales, que pueden modular o desencadenar el dolor vulvar, al encontrar un sustrato alterado a nivel de estos tejidos. Basándose en estos aspectos, hoy existen diferentes tratamientos, que son efectivos si los utilizamos asociados y en forma gradual, ya que se potencian entre ellos.
Vulvodynia is a complex pathology and difficult to treat. In 1889 Skene was the first who write about this. However, only until 1976 the members of the International Society for Study of Vulvovaginal Diseases, recognized the vulvar pain as a disease entity. Prevalence estimated at 15 percent with an estimated 14 million women who suffer in the USA. A high number of gynaecologists do not know this diagnosis. For this reason women consult multiple times and to different doctors to reach a diagnosis. There are no specific tests for diagnosis. Finding in the clinical and physical examination are the main tools for this diagnosis. The different pathologies that could explain the presence of a chronic vulvar pain must be excluded. Undoubtedly its aetiology is multifactorial, involving changes in the number of nociceptors and alterations in the innervations, and the presence of inflammatory factors that may be the starting point of this pathology, as it seeks to explain the neuropathic theory. However we can not ignore the psychosomatic theory in explaining the psychosexual disorders as a trigger vulvar pain, in these altered tissues. Based on these aspects there are now treatments that are more or less effective when are gradually associated for better results.
Subject(s)
Humans , Female , Pain/etiology , Vulvodynia/complications , Vulvodynia/diagnosis , Vulvodynia/therapy , Chronic Disease , Comorbidity , Diagnosis, Differential , Quality of Life , Vulvodynia/classification , Vulvodynia/epidemiology , Vulvodynia/physiopathologyABSTRACT
It is difficult to treat vulvar pain of an unknown cause. We report a case of vulvodynia with dysuria treated effectively with goshajinkigan. The case was 92 years-old female who could not sleep well because of vulvar pain. She did not have inflammation of the vulva or vagina. Moreover, she was sometimes treated with urethral catheterization for urinary retention. Goshajinkigan was prescribed, and her pain was decreased so much, that she could sleep well. Furthermore, she was relieved of her urinary retention.
ABSTRACT
It is difficult to treat vulvar pain of an unknown cause. We report a case of vulvodynia with dysuria treated effectively with goshajinkigan. The case was 92 years-old female who could not sleep well because of vulvar pain. She did not have inflammation of the vulva or vagina. Moreover, she was sometimes treated with urethral catheterization for urinary retention. Goshajinkigan was prescribed, and her pain was decreased so much, that she could sleep well. Furthermore, she was relieved of her urinary retention.
ABSTRACT
Perineal pain is a significant diagnostic challenge to the pain practitioner, and accurate diagnosis and treatment is essential. We report a case of 42-years old female patient suffering from excruciating vulvodynia for 5 years. Her pain on the visual analogue scale was 10 out of 10 and her pain was associated with sleep disturbance, dyspareunia, and chronic fatigue. She was diagnosed with a bladder stone by imaging, and The pain was relieved by cystolitholapaxy.
Subject(s)
Adult , Female , Humans , Diagnosis , Dyspareunia , Fatigue , Hysterectomy , Urinary Bladder Calculi , Urinary Bladder , VulvodyniaABSTRACT
Vulvodynia is the term used to describe unexplained vulvar pain, sexual dysfunction, and the resultant psychological disability. In vulvar vestibulitis, surgery is carried out on patients who have failed conservative therapy. Surgical procedures which is removal of all sensitive vestibular tissue are most effective in patients with pure vestibulitis, but effective surgery is not known in patient with dysesthetic vulvodynia. We experienced one case of vulvar denervation operation in patients with intractable dysesthetic vulvodynia, which have failed conservative therapy. So we report one case with a brief review of literature.