Quadruple Nerve Cryoneurolysis for Refractory Vulvodynia: A Case Study

Case Diagnosis: Vulvodynia s/p Hysterectomy in 2020

Case Description or Program Description: A 32-year-old female with a history of vulvodynia following hysterectomy in 2020 had been treated for several years with conservative management, including topical therapies (Ketoprofen 20%, cyclobenzaprine 2%, lidocaine 10%), oral medications (Gabapentin, Cymbalta, Ketamine), and various nerve blocks (Genitofemoral, Pudendal, Posterior Femoral Cutaneous). Her symptoms persisted despite these treatments. After prolonged trials of conservative treatments, she underwent quadruple nerve cryoneurolysis, which included the Right Pudendal, Ilio-Inguinal, Posterior Femoral Cutaneous Nerve, and Genito-Femoral Nerves.

Setting: Outpatient Pain Medicine Clinic in Florida

Assessment/Results: Post-procedure, the patient reported >80% pain relief, with sustained improvement over several months. Follow-up confirmed significant resolution of pain, without any new neurological deficits. The patient was able to return to normal daily activities and reported improved quality of life.

Discussion (relevance): This case highlights the transformative potential of quadruple nerve cryoneurolysis for patients with chronic vulvodynia, particularly for those who have not responded to traditional post-surgical management. The successful application offers a novel treatment modality that could be considered by PM&R specialists in similar cases of intractable neuropathic pain. Furthermore, this represents an important step in exploring advanced treatments and expanding the role of interventional techniques in the field, particularly in managing chronic pelvic pain syndromes. Further research is needed to evaluate the long-term outcomes of cryoneurolysis in this patient population, making this case a valuable addition to ongoing discourse in PM&R.

Conclusions: Vulvodynia is a chronic, debilitating pain condition affecting the vulvar area and is often resistant to conservative treatments. While nerve blocks have shown promise, the use of quadruple nerve cryoneurolysis as a treatment for vulvodynia is unprecedented. Cryoneurolysis, which uses extreme cold to target and disrupt nerve function, provides a novel approach to treating intractable vulvar pain. In this case, quadruple nerve cryoneurolysis led to dramatic post-surgical pain relief and sustained improvement.