Applying topical anesthetic to the vestibule about 10 to 15 minutes prior to intercourse may relieve dyspareunia (54). A case report of a single patient described pain relief for 12 months after treatment with a 6-week course of the submucosal infiltrations of betamethasone and lidocaine (55). Favorable results in 15 of 22 patients (either remission or marked improvement at 12 or 24 months of follow-up) were obtained with submucosal infiltrations of lidocaine and methyl-prednisone (56). Presumably, such treatments combine immediate anesthetic effects as well as immediate and depot anti-inflammatory or immunomodulating effects of the steroid.
Low-dose tricyclic antidepressants have been employed on the basis of their effectiveness in treating dysesthetic vulvodynia. These agents are indicated for efficacious pain reduction rather than for their effects on mood. In a series of 230 VVS patients, a three- to six-month course of low-dose amitriptyline resulted in a 60% positive response rate after five years of follow-up (3).
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