Chronic vulvar pain (CVP), although being fairly
prevalent, in most cases is not attributable to a
specified disorder, i.e., presents as vulvodynia.
There are, however, many disorders known to
cause CVP, such as radiotherapy and surgery.
There have been, so far, no reports in the literature
of effective treatment options for Iatrogenic
CVP.
Percutaneous tibial nerve stimulation (PTNS) is
a neurostimulation technique used in the treatment
of urinary urgency, frequency, urge incontinence,
and urinary retention. There has been
increasing evidence of its benefits in improving
other conditions, such as chronic pelvic pain or
sexual dysfunction.
We report a case of a 62 year-old woman with
iatrogenic chronic vulvar pain (CVP) submitted
to PTNS. The patient reported a consistent and
dramatic decrease in both frequency and intensity
of pain, assessed by the Brief Pain Inventory
(BPI). A decrease in the pain interference with
mood, normal work, and walking/mobility was also
noted, as evaluated by BPI and EQ-5D questionnaires.
Even though a relapse of symptoms was
seen after the end of the treatment protocol, it was
possible to achieve more permanent benefits after
a maintenance scheme of PTNS, with the patient
becoming almost asymptomatic.
Neuromodulation treatments have been reported
as effective in cases of vulvodynia, however
reports using PTNS are rare. The tibial nerve is
easily accessible and provides an optimal site for
neurostimulation without the need of an operating
room or anesthesia. The overall improvement
registered in this case of CVP elicits a new area
of research for PTNS. {Need key words.}
Key words: Chronic pain, pelvic pain, vulvar
diseases, neuromodulation, percutaneous electric
nerve stimulation, tibial nerve
Percutaneous Tibial Nerve Stimulation (PTNS ) in Iatrogenic
Chronic Vulvar Pain