Ganglion Impar Radiofrequency Thermocoagulation Treatmen For A Case Of Perineal Pain Caused By Atrophic Vaginitis And Literature Review

Objective:To report a case of chronic idiopathic perineal pain caused by senile atrophic vaginitis,as well as to provide supporting reference for further clinical studyMethod:A female patient,who ethnic Han and 63-year-old.The chief complaint was perineal pain for 16 years with burning,falling and bulging feeling.The medical history:16 years ago,persistent vaginal burning and bulging pain occurred and the pain aggravated in spring,winter and when mood swinged,as well as the sleep was poor.During the course,there was no abnormal vaginal bleeding,no obvious abnormal leucorrhea,no unclean sexual intercourse,no fever,no progressive weight loss,frequent constipation,and occasionally frequent micturition.Oral administration of analgesic medication as acetaminophen,oxycodone and tramadol could not achieve satisfactory results."Depressive state" was diagnosed by the psychiatrist,and the pain was relieved after using antidepressants,but it still affected daily life.The menopause age was 47.The physical examination:cranial nerves,gait,skin,muscle strength and muscle tension were normal,physiological reflex existed and no pathological reflex;the score of Self-rating Depression Scale was 60;the score of ID Pain self rating scale was 1;the Numerical Rating Score(NRS)was 4;gynecological examination showed vaginal atrophy,vaginal mucosa congestion,no obvious ulcers,and the cervical was smooth with no abnormalities.Auxiliary examination:vaginal secretions and urine lab test were negative.The vaginal ultrasound and sacral and pelvic MRI showed no abnormal changes.The vegetative nerve functional examination showed neurosism.Other routine hospitalization tests,tumor markers and coagulation time were normal.Clinical diagnosis:(1)atrophic vaginitis(2)chronic idiopathic perineal pain.Treatment plan:CT-guided ganglion impar radiofrequency thermocoagulation.Result:After the operation,perineal burning pain disappeared completely during the hospitalization period,but the falling and bulging pain still existed,which was significantly relieved,from persistent pain to intermittent pain(1～3 times/day,3～5 minutes/time).The degree of pain,the number of episodes and duration decreased day by day,and the life quality was elevated with the significantly improved sleep.There was no painful awareness and other complaint of other discomfort.Physical examination showed that ID Pain self rating score was 0 points,NRS was 1,and there was no infectious sign at the puncture point.During the postoperative follow-up,the burning pain was not occurred at the 3rd,6th,12th month after the operation,but the falling and bulging pain occurred and gradually increased 6 month later with a lower pain level compared to before.Conclusion:ganglion impar radiofrequency thermocoagulation treatment for perineal burning pain caused by senile atrophic vaginitis has a potential value.The further clinical comparative study is needed.