Alcoholisation is a procedure for damaging the ganglia or nerve fibres that conduct pain stimuli from the anatomical areas concerned through the administration of an ethyl alcohol solution. In principle, it is one of the possible treatments for dyspareunia occurring especially in the course of vulvodynia, a chronic perineal pain syndrome with an elusive cause. It is worth noting, however, that it is very difficult to find a specialist for this type of therapy, as the method is still in development and its effectiveness in treating dyspareunia is not fully understood.
Table of contents:
- What is dyspareunia?
- What could be the causes of dyspareunia?
- Treatment methods for dyspareunia
- Who is eligible for vulvar and perineal alcoholisation in dyspareunia?
- What does vulva and perineal alcoholisation involve?
- Alcoholisation of the vulva and perineum - is it available?
What is dyspareunia?
Dyspareunia is one of the more commonly identified sexual dysfunctions. It involves the occurrence of pain when attempting penetration during sexual intercourse. This phenomenon can affect both men and women, although it is much more frequently diagnosed in female patients, mainly due to the much greater number of possible causes of dyspareunia in this group. Regardless of gender, it results in a lack of pleasure from intercourse and a gradual withdrawal from intimate life, which in turn leads to serious psychological disorders.
What could be the causes of dyspareunia?
Dyspareunia in women is most often the result of inflammation of the vulval area and vaginal outlet in the course of intimate infections or of deeper organs of the reproductive system as a result of sexually transmitted diseases such as gonorrhoea or chlamydiosis. Other causes may be postoperative or postpartum lesions. A large group of patients with dyspareunia are postmenopausal women, in whom the problem of vaginal dryness is exacerbated by a decrease in oestrogen levels, which can cause pain. In patients of childbearing age, endometriosis, the presence of endometrium outside the uterine cavity, can be a problem. In women, psychological factors resulting in dyspareunia are also important in experiencing unpleasant sensations. It occurs in patients with a history of sexual abuse or fear of becoming pregnant. Unfortunately, dyspareunia can sometimes be closely related to the phenomenon of vulvodynia, i.e. the occurrence of chronic vulvar pain with no identifiable cause.
Dyspareunia can also be a male problem. In this case, the cause usually turns out to be congenital or acquired penile defects, e.g. a snaffle, a too-short frenulum, post-traumatic conditions or inflammation in the genital area.
Treatments for dyspareunia
The choice of treatment method for dyspareunia depends on the cause of the dyspareunia. If it is an infection, it should be treated, which will result in the disappearance of the pain. Depending on the causative agent, antifungal agents, antibiotics or antiviral drugs are used. If dyspareunia is found to be related to a congenital or acquired anatomical defect, irrespective of gender, surgical correction should be considered, if possible, which can restore the patient's enjoyment of sexual activity. In peri- and postmenopausal patients, oral or transdermal hormone replacement therapy should be considered to stabilise hormone levels. However, if their menopause-related complaints are limited to vaginal dryness only, a purely topical treatment with oestrogen-containing creams can be included. In many patients, psychotherapy can also be of considerable benefit. It is equally important to get to know your sexual partner - look for methods of stimulation and sexual positions that are as painless as possible and may even prove to be pleasurable.
Who is eligible for vulvar and perineal alcohol treatment for dyspareunia?
However, dyspareunia is the most difficult to treat if no cause for this unpleasant condition can be traced. This happens, for example, in the course of vulvodynia. It is to these patients that one of the treatment methods, vulvodynia and perineal alcoholisation, is directed, although this method is very difficult to access at the moment.
Alcoholisation of the vulva, photo: panthermedia
The problem of pain during intercourse is often underestimated by gynaecologists to whom female patients first go. They explain the unpleasant sensations by the anatomical mismatch between the partners. However, there are women who have had multiple sexual partners and yet intercourse with each of them has been associated with pain. In this group, too, more invasive treatment methods, such as neurolysis, should be considered.
What is vulvar and perineal alcoholisation?
Alcoholisation of the vulva and perineum, or neurolysis, involves destroying the nerve fibres innervating these structures by injecting a solution of ethyl alcohol into the area. A milder and, above all, shorter-lasting method is the so-called blockade, i.e. injecting a local anaesthetic into the same place. Possible therapy usually begins with the application of a block, and if the patient is highly effective, neurolysis may be considered, the effect of which lasts for up to several months. However, it should be borne in mind that this method is a last resort when a specific cause cannot be identified that could be treated by other means.
The doctor decides which nerve plexuses or nerve fibres will be deliberately damaged during the alcohol-assisted neurolysis procedure on the basis of an individual interview and examination of the patient. Neurolysis of the superior hypogastric plexusor the vulvar nerve is most commonly performed.
Alcoholisation of the vulva and perineum - is it available?
Neurolysis as a method of treating dyspareunia is very unpopular in Poland and is still in the research stage in most centres around the world regarding its efficacy and safety. However, this treatment is increasingly used in the palliative treatment of pain associated with cancer processes.
The biggest obstacle for patients who see vulval and perineal alcoholisation as a last resort is finding a specialist to carry out this type of procedure. This is because it requires a great deal of experience on the part of the doctor and the availability of equipment, such as an X-ray machine, to accurately administer the substance. The procedure is usually performed in the operating theatre under local anaesthesia.
