Department of Pelvic Reconstructive Surgery and Urogynaecology, St George's Hospital, 4th Floor Lanesborough Wing, Blackshaw Road, London, SW17 0QT, UK.
Arch Gynecol Obstet. 2011 Sep;284(3):681-5. doi: 10.1007/s00404-010-1763-z. Epub 2010 Nov 16.
Vaginal/perineal pain is common following obstetric trauma or vaginal surgery for prolapse and may have a serious impact on sexual function and quality of life. Local injections of corticosteroids, local anaesthetic and hyaluronidase are treatment options for chronic pain; however, there are no published studies to support their efficacy. The objective of this study was to evaluate prospectively the efficacy of perineal/vaginal injections for chronic localised pain following childbirth or vaginal surgery.
Consecutive women with chronic vaginal/perineal pain were recruited in this prospective series (audit). Pain severity and sexual function were determined using a visual analogue scale (VAS 0-10) and the abbreviated sexual function questionnaire (ASFQ) respectively. Patients underwent local injections with a combination of 0.5% bupivacaine (10 ml), hydrocortisone (100 mg) and hyaluronidase (1,500 IU). Follow-up was undertaken at four-weekly intervals. Further injections were performed as clinically indicated.
Fifty-three women underwent ≥1 injections [mean: 1.86 (range: 1-4)]. Mean interval from index childbirth [43/53 (81%)] or surgical intervention [10/53 (19%)] was 8 months (range 12 weeks-20 years). Twenty-seven women (51%) were sexually active. All reported dyspareunia. Fifteen (28%) women required 1 and 31(59%) two injections. Pre treatment VAS pain scores were 6.1 versus 4.1 after first injection (p = 0.0002, 95% CI 1.01-3.05) and mean ASFQ scores increased from 18.1 to 29.1 (p = 0.01, 95% CI -17.2 to -2.3) 4 weeks post-injection. There were no adverse events or morbidity. 24/27 (89%) sexually active women with dyspareunia resolved and 18/26 (69%) sexually inactive women resumed satisfactory sexual activity 8 weeks post-injection.
In our series, this treatment was well tolerated and significant improvements in pain scores and sexual function were observed.
产科创伤或阴道手术治疗脱垂后，阴道/会阴疼痛很常见，可能对性功能和生活质量产生严重影响。皮质类固醇、局部麻醉剂和透明质酸酶的局部注射是慢性疼痛的治疗选择；然而，目前还没有研究支持它们的疗效。本研究的目的是前瞻性评估会阴/阴道注射治疗分娩或阴道手术后慢性局部疼痛的疗效。
本前瞻性系列研究（审计）招募了患有慢性阴道/会阴疼痛的连续女性患者。疼痛严重程度和性功能分别使用视觉模拟评分（VAS 0-10）和简化性功能问卷（ASFQ）进行评估。患者接受了含有 0.5%布比卡因（10 毫升）、氢化可的松（100 毫克）和透明质酸酶（1500IU）的联合局部注射。每四周进行一次随访。根据临床需要进行进一步注射。
53 名女性接受了≥1 次注射[平均：1.86（范围：1-4）]。指数分娩[43/53（81%）]或手术干预[10/53（19%）]后的平均间隔时间为 8 个月（范围 12 周-20 年）。27 名女性（51%）有性生活。所有人都报告性交困难。15 名（28%）女性需要 1 次注射，31 名（59%）女性需要 2 次注射。治疗前 VAS 疼痛评分分别为 6.1 和第一次注射后 4.1（p=0.0002，95%CI 1.01-3.05），平均 ASFQ 评分从 18.1 增加到 29.1（p=0.01，95%CI-17.2 至-2.3）在注射后 4 周。没有不良事件或发病率。27 名有性交困难的有性生活女性中有 24 名（89%）得到缓解，26 名无性生活女性中有 18 名（69%）在注射后 8 周恢复满意的性生活。
在我们的系列中，这种治疗方法耐受性良好，疼痛评分和性功能显著改善。
