FLASHLAMP-EXCITED DYE-LASER THERAPY OF IDIOPATHIC VULVODYNIA IS SAFE AND EFFICACIOUS

OBJECTIVE: The management of chronic vulvovaginal pain, not explicable on specific histologic grounds, presents a major problem in referral centers for lower genital tract diseases. STUDY DESIGN: This article r eports on a two-step protocol in a sample of 175 medical nonresponders , drawn from a 2-year cohort of 725 women with vulvovaginal pain. The first maneuver was the use of a flashlamp-excited dye laser to selecti vely photocoagulate symptomatic subepithelial blood vessels in 168 wom en; the second was the microsurgical removal of chronically painful Ba rtholin's glands in 52 women not responsive or not suited to flashlamp -excited dye laser photothermolysis. RESULTS: Dye laser response rates were independent of whether patients manifested macroscopic foci of p ainful erythema (''vestibular adenitis'') or just colposcopically appa rent hyperemia-ectasia of the individual blood vessels (''pruritic pap illomatosis'') (56% vs 45% after a single surgical procedure; 76% vs 6 5% after serial retreatment; p not significant). Conversely, response rates were much lower among women in whom pressure on the Bartholin's glands produced sharp, lancinating pain (15% vs 66% after a single sur gical procedure; 22% vs 93% after serial retreatment; p < 0.001). Fort y-two (85%) of 50 patients with flashlamp-excited dye laser failure ha d deep pain; however, the impasse to progress was broken by gland remo val. Final response rates were 92.5% (complete response 62%; partial r esponse 30%) in the ''surface-only'' group and 80.3% in the ''surface- plus-deep'' group (chi(2) = 14.9; p < 0.001). The major complication w as acute bacterial cellulitis, occurring in the first postoperative we ek. Modification of the treatment protocol to include topical antibiot ics with an occlusive dressing reduced the cellulitis rate from 17.2% to 2.5%. in four women (1.8%) Koebner-like exophytic condylomas also d eveloped within 1 month of flashlamp-excited dye laser surgery. CONCLU SION: The availability of a safe, efficacious, acid relatively noninva sive treatment should reduce the need for resective surgery in most pa tients with idiopathic vulvodynia.