A Novel Multimodal Treatment Method and Pilot Feasibility Study for Vaginismus: Initial Experience With the Combination of Sacral Erector Spinae Plane Block and Progressive Dilatation

Emsal Pinar Topdagi Yilmaz, Elif Oral Ahiskalioglu, Ali Ahiskalioglu, Serkan Tulgar, Muhammed E Aydin, Yakup Kumtepe, Emsal Pinar Topdagi Yilmaz, Elif Oral Ahiskalioglu, Ali Ahiskalioglu, Serkan Tulgar, Muhammed E Aydin, Yakup Kumtepe

Abstract

Background Genito-pelvic pain/penetration disorder, commonly referred to as vaginismus, is a relatively common condition in women of childbearing age and has physical and psychological aspects. Various cognitive and behavioral therapies, dilatators, botulinum injections, and so on have been tried in the treatment. We hypothesize that the combination of sacral erector spinae plane (ESP) block and progressive dilatation treatment increases treatment quality. Methods We performed the sacral ESP block and progressive dilatation, which we added to multimodal treatment for resistant vaginismus cases. After the procedure, all patients were followed up during one menstrual cycle. They were recommended to have sexual intercourse on the day of the procedure. Results In 15 of our treatment-resistant cases, when we added the sacral ESP block, successful penetration after the first block was 73%. Pregnancy occurred in eight patients after the initial one-month follow-up. Four of the 15 patients needed a second block. Conclusions The sacral ESP block added to the multimodal treatment protocol significantly improves treatment quality.

Keywords: erector spinae plane block; multimodal treatment; progressive vaginal dilatation; sacral; ultrasound; vaginismus.

Conflict of interest statement

The authors have declared that no competing interests exist.

Copyright © 2020, Topdagi Yilmaz et al.

Figures

Figure 1. Basic illustration of sacral erector…
Figure 1. Basic illustration of sacral erector spinae plane block
Image created by the authors of the current article
Figure 2. Patient and ultrasound setup for…
Figure 2. Patient and ultrasound setup for sacral erector spinae plane block; sonographic anatomy of the block
L5: lumbar 5th vertebrae; ESM: erector spinae muscle

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