CHICAGO — Long-term use of 5% lidocaine ointment shows promise as a treatment for the management of vulvar vestibulitis, vaginal apex pain, and intrinsic cervical pain, John Steege, M.D., said at a meeting sponsored by the International Pelvic Pain Society.
“We started out with vestibulitis pain and moved on to vaginal apex pain, and overnight lidocaine works pretty well,” said Dr. Steege of the division of advanced laparoscopic and gynecologic surgery at the University of North Carolina, Chapel Hill. “We've done 52 vaginal apex revisions, but we've slowed down on that in the last few years because the overnight lidocaine works pretty well.”
Dr. Steege credits colleague Dennis Zolnoun, M.D., of the department of ob.gyn. at the university, for the thinking behind the treatment. In a small study last year, Dr. Zolnoun and colleagues treated 61 women who presented with introital pain and met the criteria for vulvar vestibulitis.
After a mean of 7 weeks of nightly treatment with 5% lidocaine ointment, 76% of women reported the ability to have intercourse, compared with 36% before treatment. Intercourse-related pain score was 39 points on a 100-mm visual analog scale after treatment, with a decrease of 10 points in daily pain score.
They found no association between the response to nightly treatment with lidocaine ointment and prior episodic use of lidocaine.
Dr. Steege said the treatment has evolved from a nightly application of lidocaine ointment to a three-times-daily application. Topical estrogen also is sometimes added.
Some patients with intrinsic cervical pain are treated with 5% lidocaine using a diaphragm. In these patients, “the cervix looks fine, but if you take a [cotton swab] and walk it around the cervix, at 3 o'clock it hurts; sometimes after deliveries, but sometimes it's plain out of the blue,” Dr. Steege said. “Have them use a diaphragm with a little lidocaine jelly in it overnight and keep it anesthetized for 8 hours out of the day, and a fair amount get better. You're treating it like a neuropathic pain.”
Dr. Steege said that changes in the last 20 years in the way pelvic pain is viewed, as well as cross talk between disciplines, have opened new avenues for the clinical treatment of pelvic pain. This includes using local anesthetics whenever possible together with physical therapy techniques and medications aimed at peripheral somatic changes and central changes, respectively.