We wanted to share a success story:
A patient presented to our office with years of frustrating debilitating pain in the perineum area (around the vagina), left internal vaginal wall, and the left labia. This patient had previously seen her GYN, had evaluations and therapy and she had a surgical procedure called a vestibulectomy which includes a resection or removal of some of the vaginal wall lining, near the entrance of the vagina. Unfortunately, her pain did not improve but only worsened after the operation and she suffered for several years. She was sent to pelvic therapy for desensitization and dilatation of the vaginal opening. Unfortunately this did not help either. She tried and failed many medications. Her pain was slightly different after the vestibulectomy in that it was more “electric”, more hypersensitive, and painfully sensitive to even light touch. She was in pain 24/7 in this region. As you might imagine this interfered with many areas of life including her most intimate relationships. But even finding clothes to wear due to the pain was difficult.
We were able to diagnose her with a suspected neuroma of the perineal branches of the pudendal nerve causing her terrible pain around the opening of the vagina and in the perineum. We came to this diagnosis because her pain worsened after the vestibulectomy procedure and the neuropathic sensations of burning, pain, and painful hypersensitivity in the region of a known nerve. It was very important for our diagnosis that this new pain occurred AFTER another operation in the region of her pain. Every operation has risks, and every operation in every location on the body has the potential to cut nerve branches – hence the reason we need to put people to sleep for surgery – ie. It hurts because there are nerves. But most of us will heal and for most patients the small nerve endings go on to heal without problems, and we resume our lives.
However, for this particular patient, and there are others like her, she did not go on to heal normally after her vestibulectomy. We suspected that the nerve endings healed abnormally in what is called a painful neuroma, or ball of painful nerve scar. A diagnostic block with local anesthetic temporarily resolved her pain. We elected to remove these nerve branches due to the amount of life limiting pain that she was in.
IT has now been over 18 months since the removal of these nerves, and she continues to have wonderful relief of pain that has allowed her to enjoy normal activities with her partner, and because the main nerves from the pudendal nerve that are responsible for arousal were not affected, she is able to enjoy pain free sexual function again.
We hope to be able to offer this approach to other women who have persistent or worsening pain after vestibulectomy procedures, or patients who have chronic pain after bartholin cyst excision, or episiotomy. Many of these patients who have chronic persistent pain after these procedures may have injuries to the perineal branches of the pudendal nerves leading to severe, burning, hypersensitivity, electrical shocking pain in and around the vaginal canal and on the external skin in the labia majora and labia minora and perineum due to these small branches being inadvertently injured or stuck in scar tissue, or caught in sutures closing these wounds. These nerves can often be treated and relief restored in many patients.