extreme vulva pain
44 year old female presents with extreme vulva pain which has been persistent for about 1 year. The client has been diagnosed with dysthetic vulvodynia. She has had numerous surgeries dating back to 1996 including 2 laporoscopies, a hysterectomy, removal of cysts, a bladder suspension, tubes tied, and most recently an ovary removal. She is currently taking Oxycontin & Oxycodone (narcotic analgesics), Lyrica (nerve pain), Baclofen (muscle relaxant), Effexor (anti-depressant).
The pain is dull and sometimes burning in one spot, radiates into the lower abdomen and also pinpointed in the vulva. The pain is worse with stress. She has no vaginal mucus and experiences dryness in the genital area. She does not suffer from nightsweats although she has before as she was put into menopause by a medication she was taking for ovary pain prior to its removal. Her eyes are not dry/ burning/ or itching but tend to water a lot. She has dark circles under her eyes. She experiences dryness in her mouth (also a known side effect of lyrica.)
She has bowel movements every other day with dry ‘nugget’-like stool and she has to manually manipulate and massage her rectum to pass it. She also has bladder prolapse and wakes once or twice to urinate. She experiences depression, stress, anxiety, grief, sadness, emotional eating and she sighs. She gets restless and easily agitated, snores, and craves sweets.
Before her hysterectomy in 1997 she had heavy bright red menstruation. (The hysterectomy was a result of extreme pain that lasted over 3 weeks possibly due to endometriosis.) She experienced dysmenorrhea from days 1 through 3 that was dull and relieved with heat. Premenstrually she experienced breast tenderness, acne, and bloating. She has had 2 pregnancies and now has 2 children.
44 year old female presents with extreme vulva pain which has been persistent for about 1 year. The client has been diagnosed with dysthetic vulvodynia. She has had numerous surgeries dating back to 1996 including 2 laporoscopies, a hysterectomy, removal of cysts, a bladder suspension, tubes tied, and most recently an ovary removal. She is currently taking Oxycontin & Oxycodone (narcotic analgesics), Lyrica (nerve pain), Baclofen (muscle relaxant), Effexor (anti-depressant).
The pain is dull and sometimes burning in one spot, radiates into the lower abdomen and also pinpointed in the vulva. The pain is worse with stress. She has no vaginal mucus and experiences dryness in the genital area. She does not suffer from nightsweats although she has before as she was put into menopause by a medication she was taking for ovary pain prior to its removal. Her eyes are not dry/ burning/ or itching but tend to water a lot. She has dark circles under her eyes. She experiences dryness in her mouth (also a known side effect of lyrica.)
She has bowel movements every other day with dry ‘nugget’-like stool and she has to manually manipulate and massage her rectum to pass it. She also has bladder prolapse and wakes once or twice to urinate. She experiences depression, stress, anxiety, grief, sadness, emotional eating and she sighs. She gets restless and easily agitated, snores, and craves sweets.
Before her hysterectomy in 1997 she had heavy bright red menstruation. (The hysterectomy was a result of extreme pain that lasted over 3 weeks possibly due to endometriosis.) She experienced dysmenorrhea from days 1 through 3 that was dull and relieved with heat. Premenstrually she experienced breast tenderness, acne, and bloating. She has had 2 pregnancies and now has 2 children.
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team discussion
Hi all, this is a challenging case that came through. She came in for three acupuncture sessions three days in a row. She had relief the first day while she was on the table but it returned as soon as she left treatment. The second and third days she didn't experience the same pain relief, I used some additional points and e-stim on the second day. I'll elaborate on the points I used (and why) this afternoon when I'm in clinic and can refer to her file. I'm afraid I'm shamefully sorry that I was so distracted by her obviously extreme vulva discomfort and pain that I neglected to check her pulse and tongue. BAD i know. BAD. I told her that we would consult as a team to put our heads together for some more options. I'm wary of prescribing herbs as she is already so 'poly-pharmacied'.....any thoughts?
Hey Alda what points did
Hey Alda
what points did you use ?
Thanks
Ryan
Clarification...
Can you clarify this point?
"The pain is dull and sometimes burning in one spot, radiates into the lower abdomen and also pinpointed in the vulva. "
The pain is in one spot and radiates into the lower abdomen. Where is the pain orginating from (or where does it feel like it is orginating from at least).
Just some general thoughts. My clinical experience is limited, so take this with a grain of salt...
There are many things going on here, and usually when that is the case, I look straight to the source (Kd/ SP) first. What can I say, I am a Spleen/ Stomach abdomenal kind of guy. Another huge alarm bell is the multiple surgies and scars on the abdomen which are likely to cause aother problems in the meridians, esp pain.
Clearing these scars with acupuncture would be one of my main concerns. Often it can block/ hide the root patterns by cause various painfull/cold/numb/hot,etc symptoms in the body. From this approach you have two things to do.
1. First palpate the scares themselves, and see if any of them are tender. If the scars themseleves are tender, you need to look for other areas in the abdomen that refer that pain. For example, you palpate the hystorectomy scar. It is painfull to touch. Then you palpate the rest of the abdomen. You find that pressing around Ren 12, recreates/transfers the pain in the scar area. Then, Ren 12 becomes a treatment point. Needle Ren 12 and re-palpate the scar. The pain should be reduced at least some.
This can take some time to find the distal areas which to needle but it is important. If your tx is succussfull, then the pain will be less at the site of the scar.
2. Once step 1 is completed, or if the scars themselves are not painfull, then time to tx the scar area itself.
Step 2 is about treating around the scar area itself. There are various ways to do it, but most ppl's tx revolve around using 2 to 4 needles around the edge of the scar going inwards. Like circling the dragon idea. You want to find reactive points/ red point/ etc in which to place the needles if possible. If you cannot find these, trust your intuition.
Often if you press on these scars, they recreate/transfer pain to other areas of the body. This helps you to know that that scar particularily is important to treat.
I know Kiiko Matsumoto does a bit of this in her DVD at pro-d, but this is not an exclusive treatment to her style.
My next major concern would be trigger points. I know this is also not a very "TCM"ie thing to consider or do, but works well for vulva/prostate/penis pain in my short clinical experience. It is also not a root tx, but very important in breaking the pain cycle. Pressing firmly in the lower abdomen, inner thighs, !!! perinunm area!!, around and yes, in, the rectum (something you may not want to do). You will find points that strongly trigger her vulva pain more than likely. Needling these can help, but she needs to learn to press them daily. At first they seems to make the S/s worse, but within a few weeks the pain will reduce. This takes months if not years depending on how chronic the pain is. Its always two steps forwards, one step back.
After identifying which key muscles are involved, you need to add stretches involving those muscles that she can do twice a day at home.
Also in her case, it sounds like she needs some relaxation/ councilling/ learning to meditate and take time for herself. But no one can make her do that but her. But she really needs to understand that that is the only way she is really gonna get better...
Apply herbs and acu, and send home happy.... lol :)
Hope this wasent too much. Alot was assumed about the case, but I find this tx works.
PS
PS, I am wearing a stethoscope, you must listen to me, or the AMA will come for you!!!
where is your pic?