Vulvodynia

[pod70]

I have had vulvodynia for 3 years.
I have been tested for every infection and it has come back clear.
I have tried numerous steroids, oestrogen cream, physio and recently came off the pill and had a few acupuncture sessions.
Amitriptyline helped my bladder pain (I also get interstitial cycstitis) but made me gain weight, even at a low dose.

I have been told my final option is Gabapentin, but am reluctant to try this due to potential side effects - do you have any other suggestions?

I am investigating hypoallergenic underwear as I believe this is a skin problem as opposed to a nerve one.

[Dr Amanda Tristram]

I'm afraid I don't have any other good suggestions. After everything else you've been through and tried, gabapentin is the next thing on the list. It might be worth trying it, not everyone gets side effects and they go away when you stop taking it. The best thing is to build up the dose gradually. I would suggest trying it and then you can see if the benefits outweigh the side effects. It may be a skin problem, although this is probably unlikely, given that steroids didn't help you.

[Mr. Hugh Byrne, MRCOG]

Other possibilities include injections of botox, or combinations of an anaesthetic/hyaluronidase and steroid in injection form.

[Mr Stelios Doumouchtsis]

These problems require a systematic approach and of course detailed information related to history, onset of the symptoms, aggravating / exacerbating or relieving factors, any previous or recent childbirth or surgery.

It is important to differentiate if this is predominantly a skin problem or neuropathic pain.

In many cases a combined treatment approach may be more efficacious including oral medication, topical treatments and also nerve blocks (injections).

Usually in cases where injections are required, a series of injections may provide more sustained resolution.

Please see our study results on the management of chronic pain in the link below.

http://www.ncbi.nlm.nih.gov/pubmed/?ter ... s+perineal