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

OBJECTIVE: To assess the efficacy of submucous infiltrations of methylprednisolone and lidocaine into the vulvar vestibule for the treatment of vulvar vestibulitis.

STUDY DESIGN: Twenty-two patients were referred for vulvar vestibulitis. Methylprednisolone and lidocaine were injected into the vulvar vestibule once a week for three weeks at decreasing doses (1, 0.5, 0.3 mL). Follow-up was performed monthly for three months, then at six and nine months. Fourteen women have had 12 months and 5 women, 24 months of follow-up.

RESULTS: Fifteen women (68%) responded favorably to the treatment, seven (32%) with absence of symptoms and eight (36%) with a marked improvement. Seven patients (32%) failed to respond in spite of a fourth dose (0.3 mL) given 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 needed 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 deposited in the submucosa, the site of the inflammatory reaction, while the depot formulation allows gradual and prolonged release of the drug. Seven patients (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.