To act specifically on the neuropathic component of vulvodinia, a recent Taiwanese study tested the efficacy of a method, hydrodissection, already known and used in several medical fields. The aim was to try to relieve vulvar pain in a safe, minimally invasive way with long-lasting benefits. This confirms that research to find new therapeutic solutions to intimate pain to be included in multidisciplinary protocols is increasingly active.
What is hydrodissection
Hydrodissection is a medical technique that involves the injection of a fluid, such as a saline solution, sometimes combined with other substances such as local anesthetics or corticosteroids, to gently “separate” adherent layers of tissue, or release compressed nerve or vascular structures that are causing pain.
The treatment is simple and generally well tolerated: the doctor, after identifying the affected nerves by ultrasound, injects the solution that goes on to “separate” the nerve from the adherent connective tissues, freeing it from the compression responsible for the pain while reducing inflammation and hyperactivity. This is a technique already used in several branches of medicine, from ophthalmology to surgery, which is considered safe, requires no recovery time (it takes place on an outpatient basis) and has no side effects (it may cause only a slight tingling sensation at the time of injection).
Hydrodissection applied to vulvodinia
In recent years, nerve hydrodissection based on 5% dextrosed water (a solution of water and sugar) has been studied for the treatment of several neurological conditions such as carpal tunnel syndrome and sciatica.
The study, conducted in October 2024 at the Department of Obstetrics and Gynecology of the Chung Shan University Hospital of Medicine and the Department of Physical Medicine and Rehabilitation of the New Taiping Cheng Ching Hospital in Taiwan (East Asia), started from the assumption that vulvodinia is often associated with abnormal activity of certain nerves, such as the pudendal nerve, and that, therefore, specific intervention is also needed on the neuropathic front to relieve pain and associated symptoms. He therefore wanted to test the efficacy of a 5% solution of dextrous water and lidocaina, a local anesthetic, as a treatment for vulvodinia with a neuropathic component.
The study involved 49 women with an average age of 47 years, who reported symptoms of vulvodinia, including pain, dispareunia (sexual pain) and sexual dysfunction, persisting for more than three months. Most had pain in several places (an average of two or three), including, most frequently, at the level of the hymenal ring (in about 51 percent of cases), in the bilateral paraurethral grooves (small fissures on the sides of the urethral canal, in about 30 percent of cases) and in the area around the postpartum scar (about 28 percent).
Each woman was given the treatment, consisting of a submucosal injection of 5% dextrous water and lidocaina, on an outpatient basis. Pain level was self-rated by the participants using a specific scale, both before treatment and after each session.
Results
The results of the work were encouraging: the mean pain score decreased dramatically, and the improvement was maintained for a significant period of three to six months. No serious adverse events were reported in any of the participants, either during or after treatment.
The scientists therefore suggest that targeted submucosal hydrodissection with 5% dextrosated water and lidocaina may be an attractive treatment modality for vulvodinia, offering significant and sustained pain relief over time. They conclude, however, that treatment of such a complex condition remains multilevel and that further confirmatory studies are needed. In fact, this work does not specify, for example, the number of hydrodissection sessions needed to reduce vulvar pain, but proposed individualized treatment plans to participants based on the severity and persistence of their symptoms.