Treatment of vulvar vestibulitis with submucous infiltrations of methylprednisolone and lidocaine - An alternative approach

OBJECTIVE: To assess the efficacy of submucous infiltrations of methylpredn isolone and lidocaine into the vulvar vestibule for the treatment of vulvar vestibulitis. STUDY DESIGN: Twenty-two patients were referred for vulvar vestibulitis. Me thylprednisolone and lidocaine were injected into the vulvar vestibule once a week for three weeks at decreasing doses (1, 0.5, 0.3 mL). Followup was performed monthly for three months, then at six and nine months. Fourteen w omen have had 12 months and 5 women, 24 months of follow-up. RESULTS: Fifteen women (68%) responded favorably to the treatment, seven (3 2%) with absence of symptoms and eight (36%) with a marked improvement. Sev en patients (32%) failed to respond in spite of a fourth dose (0.3 mL) give n after 30 days. No relapse was observed at nine months' follow-up, while a further 0.5 mL infiltration followed by quick remission of symptoms was ne eded after one year in five patients. Five patients completed the 24 months ' follow-up, with no need for further treatment. CONCLUSION: Submucous infiltration allows methylprednisolone to be deposite d in the submucosa, the site of the inflammatory reaction, while the depot formulation allows gradual and prolonged release of the drug. Seven patient s (32%) failed to respond, suggesting either that they had a kind of vulvar vestibulitis syndrome where inflammation is less remarkable or failure of the infiltrated drug to become adequately diffused.