[Use of transcutaneous electrical stimulation and biofeedback for the treatment of vulvodynia (vulvar vestibular syndrome): result of 3 years of experience]. / Utilizzo dell'elettro-analgesia transcutanea e del biofeedback nel trattamento della vulvodinia: risultati di 3 anni di esperienza.

AIM: The safety, tolerability and efficacy of physical therapy with biofeedback and trans electrical nerve stimulation (TENS) with intravaginal probe for the treatment of vulvar pain and vulvar discomfort in women with vulvodynia, is evalued in the present study. Vulvodinia is a cronic syndrome of unexplained vulvar pain. Patients typically present with a history of intermittent or continuous, localized, vulvar pain, frequently accompanied by sexual dysfunction like entry dispareunia, burning and hiching localized to the vulvar vestibule. METHODS: From January 2005 and June 2007, a total 145 women diagnosed with vulvodynia presented in the ambulatory for the Diagnosis and Treatment of Vulvar Pain and Pelvic Floor Dysfunction, Clinical ''Santa Famiglia'', Rome. Patients were treated with weekly biofeedback (BFB) and transcutaneous electroanalgesia (TENS), in association with functional electrical stimulation (FES) and home-therapy with stretching exercise of pelvic floor. RESULTS: Hundred forty-five women completed both the biofeedback and trans electric nerve stimulation treatment for a total of 10 application, with a improvement of vulvar pain in 75.8% of cases. CONCLUSION: The pelvic floor relaxation with biofeedback and ellectroanalgesia is safe and effective in improvement in vulvar pain and dyspareunia in women with vulvodynia.

[Topical imiquimod cream in the treatment of external anogenital warts: personal experience]. / Utilizzo dell'Imiquimod nel trattamento della condilomatosi ano-genitale. Nostra esperienza.

AIM: The clinical effects of home-therapy with 5% imiquimod cream in the treatment of cutaneous anogenital warts are evaluated. METHODS: From March 2000 to January 2002, 57 women presenting clinical cutaneous external genital and perianal warts were selected in the base-population observed at our clinical of vulvar pathology and sexually transmitted diseases, AIED Rome. The patients were divided into 2 groups: Group A, with new cutaneous viral lesions and Group B with recurrent anogenital warts pre-treated with CO2-laser therapy. A total of 36% (20) of all patients presented contemporaneous HPV lesions of cervix and/or vaginal wall. The follow-up was carried out at 4 weeks, 3 months and 6 months, evaluating the safety, clinical efficacy and tolerance of women. The Pearson chi2 test was used to evaluate trends significance. All lesions were photo-documented. RESULTS: Sixty-four per cent (64%) of the patients had complete clearance of anogenital warts within 16 weeks, for 3 times per week self-application of imiquimod, with clinical remission at short term (6/8 weeks) (chi2=1.42; p<0.05); 12% had partial clearance (<50%) and 20% had a clearance of about 75%. The coexistent lesions of cervix and/or vaginal walls had a high remission (>50%) and required surgical additional therapy with CO2-laser; 28% of patients (16/57) experienced mild to moderate drug-related side effects. There was a significant increase in the severity of local skin reactions due to the increased time and number of applications. CONCLUSION: These data confirm that imiquimod cream at the dose regimen of 3 times per week, is effective and well tolerated in the treatment of cutaneous external warts and is associated to a reduction of coexistent mucous viral lesions due to enhancement of local immune response.