Coccygodynia and Vulvodynia
Coccygodynia is painful condition localized in the region of the coccyx or tail bone. A history of trauma is usually present or else it can be idiopathic or referred from viscera. The diagnosis is made based on the typical medical history whereby the pain is provoked by prolonged sitting and cycling. X rays with lateral images of coccyx might be done.
Coccygoynia is usually managed in the acute phase with the NSAIDs. Treatment for patients with severe pain in the chronic phase consists of manual therapy and/or a local injection of local anesthetic and corticosteroid into the painful segment.
The Ganglion Impar block and its radiofrequency is done once pain is not managed conservatively or local injection. The ganglion impar is located just anterior to the sacrococcygeal junction and is approached through that with a small length needle.
Vulvodynia is a vulvar discomfort with typical burning pain coupled with dyspareunia (pain during intercourse), stinging, irritation and rawness. This is usually seen in reproductive age and is not very uncommon.
There are several subgroups of vulvodynia with vulvar dermatoses, candidiasis or vulvitis which have known cause and can be treated with medicines either oral or topical. Vulvar vestibulitis syndrome (VVS) and Dysaesthetic vulvodynia are unknown causes wherein while in VVS the vulvar vestibule is profoundly hypersensitive to stimulation and has varying degree of erythema (redness), in dysesthetic vulvodynia, these findings are absent.
For the management of vulvodynia, behavioural therapy along with pelvic floor muscle training have been found to be useful. Among the interventions Pudendal nerve block and ganglion impar block are done in order to manage vulvodynia pain. Surgeries such as vestibulectomy has been shown to have favourable outcome.