title: Prospective evaluation of combined local bupivacaine and steroid injections for the management of chronic vaginal and perineal pain.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  In our series, this treatment was well tolerated and significant improvements in pain scores and sexual function were observed.
authors.affiliation: Department of Pelvic Reconstructive Surgery and Urogynaecology, St George's Hospital, 4th Floor Lanesborough Wing, Blackshaw Road, London, SW17 0QT, UK. sdoum@yahoo.com
authors.forename: Stergios K
authors.initials: SK
authors.lastname: Doumouchtsis
authors.forename: Vincent
authors.initials: V
authors.lastname: Boama
authors.forename: Mahalakshmi
authors.initials: M
authors.lastname: Gorti
authors.forename: Safwat
authors.initials: S
authors.lastname: Tosson
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Fynes
mesh_terms: D000328:Adult; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use*; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002045:Bupivacaine / Q000008:administration & dosage / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D004414:Dyspareunia / Q000188:drug therapy*; D004841:Episiotomy / Q000009:adverse effects; D005260:Female; D006801:Humans; D006821:Hyaluronoglucosaminidase / Q000008:administration & dosage / Q000627:therapeutic use; D006854:Hydrocortisone / Q000008:administration & dosage / Q000627:therapeutic use*; D008875:Middle Aged; D010149:Postoperative Pain / Q000188:drug therapy*; D010502:Perineum / Q000293:injuries; D049590:Postpartum Period; D011446:Prospective Studies; D012725:Sexual Behavior; D014621:Vagina / Q000601:surgery; D055815:Young Adult
chemical_list: D000779:Anesthetics, Local; D000893:Anti-Inflammatory Agents; D006821:Hyaluronoglucosaminidase; D006854:Hydrocortisone; D002045:Bupivacaine