3 Ways to Use Lidocaine
When I first got diagnosed with VVS, I went to a whole succession of doctors who all gave me one thing: Lidocaine ointment. "Use as needed" was mostly what I was told. So at first, I went a little overboard on using it. I basically tried to numb my pain into submission; I used it every 20 minutes or so throughout the day and washed it off between uses. Needless to say, I didn't get the best results.
I soon came to equate the prescription of Lidocaine to a sign of a bad doctor. "Don't they have anything else they know how to prescribe?" I would think to myself. And yes: there are many, many possible treatments for VVS. But I've learned over the years that lidocaine does indeed have its' place in the possible VVS treatments.
And I've just recently learned from the pelvic pain specialist I went to just how much it can help: he said that over 75% of his patients get relief from some kind of lidocaine treatment. There are 3 main ones that I'd like to cover today.
The first one is the one you are probably most familiar with (or at least something close to this):
1) Using Lidocaine (5%) every night by putting it on a cotton ball and inserting in the opening of the vagina.
Yet for how commonly it is talked about/prescribed, I think it is the one that is most misused. In my case, for example, I think it overused it and didn't leave it on for long enough periods at a time before I reapplied (I used to wash it off between applications).
The whole idea behind using Lidocaine in this way is that it soaks through all of the layers of skin to get to the needlessly-firing nerves down below; so this is why my pelvic pain specialist said that it is crucial for it to be on there for an adequate amount of time.
When used correctly, he gave me the impression that Lidocaine does have a fairly high chance of decreasing pain levels. I haven't been able to find too much hard data so that I can throw some numbers at you but my pelvic pain specialist cited (note however: he's only one person) that nearly 50% of his patients find that their vestibular pain decreases by following this regiment. (Again, we're not talking about a "cure" here really, we're talking about getting pain levels to decrease. That being said, there are some women who, once they got those nerves under control, did get total relief. Alas, "trial and error" strikes again.)
For those of you who are interested in trying this out, I do have a couple suggestions:
a) 5% Lidocaine is the best one to use for this because it is the strongest and therefore most effective at soaking into the skin and getting to the nerves.
b) In my personal experience, I have had more luck using cotton rounds rather than cotton balls (by cotton rounds, I mean the little flat, round ones you would use for makeup removal; here's what I'm talking about.
I have heard (and experienced personally) that cotton balls often hurt women with VVS who try this but I've had much better luck with soaking topical ointments onto the flat cotton rounds and then placing them gently against the opening of the vagina. It helps to spread the lidocaine over the entire cotton round so that it molds against the skin easier (and because of the consistency, it won't rub as harshly against the skin).
Side note: the 5% lidocaine ointment is not very runny so I often liquefy it by applying some sort of heat (I used a hair dryer for a couple seconds) and then spreading it on the cotton round. I've experienced that it liquefies once it is against your skin for a bit so I have found that it gets more comfortable after about a half an hour or so.
While this treatment definitely has potential, I have heard of women who have tried this approach--the right way--and were bothered by the Lidocaine. (I know that the notion of creating wet environment in your vagina makes those of you with yeast problems slightly uncomfortable. If this is you but you still want to try the topical Lidocaine, what I have had luck with is using vaginal suppositories called Gynatren in conjuction with the above treatment.)
But luckily, there are 2 more ways left to get relief from the Lidocaine if this way doesn't work out for you:
2) Lidocaine patches; used every day.
There's not a whole lot more to say on this use of Lidocaine as it pretty much works on the exact same principle as the one above. The main difference is that it is not directly placed on the most irritated area so you're less likely to experience negative side effects.
This version is especially great for those of you who do a great deal of sitting throughout the day. On top of that, they are pretty easy to use; just stick them on and go about your business. You might have to experiment with where it helps most to put them on (I was told--but check with the doctor you get your prescription from--that you can use up to 3 at a time and can cut them in half to cover areas). However, the place that they can't be used is on any mucous membranes.
Here's an article that talks about the effectiveness of this treatment (it's not about vulvar pain but it talks about other nerve pain which is what we're really interested in here).
The 2 uses of Lidocaine that I mentioned above are the least invasive of the 3. The 3rd one is reserved for the patients who either don't respond to the 2 treatments above or the patients who have been struggling with VVS for a very long amount of time (at that point, you usually want to break out the big guns as soon as possible).
(Note: that is not to say that the patches or cotton rounds version won't work for you but the injections give immediate relief that lasts for at least several hours if not days after your first injection and the amount of relief you get should, in theory, increase the more you get them done.)
3) Lidocaine injections
Injections are considered to be the most direct way to use Lidocaine because it gets the medicine directly to the nerves. This means that you get immediate feedback on if it worked or not (the doctor will press a cotton swab onto the vestibule to see if you can feel it) and that means that you get instant relief from the pain. It was quite the revelation for me: wow, I really don't feel pain where he is touching!
Unfortunately, that is not to say that you are guaranteed not to feel any pain at all. If you've had VVS for years, there's a chance that your muscles are starting to refer pain. In my experience, I had total and complete relief from pain on contact (the pain I feel with penetration); but it did not help the pain that is categorized as "Generalized Vulvodynia" which I can thank my spasm-ing muscles for. When I was able to get home to do my relaxation exercises and at-home massage routine, however, I did feel total relief from the pain.
While it is disappointing that a shot can't remove all pain, I was able to pinpoint exactly what physiological cause contributes to each kind of pain. Now when I feel the burning/hot pain around my vulva, I know that I need to do my deep breathing exercises, relaxation exercises, and massages to remove that pain. With pain on contact, I will be using my lidocaine ointment/patches, Traumeel, etc. (check out my case study for the details as there are too many things to mention here).
The thing is, the generalizes vulvodynia is the pain I feel that I have control over, thanks to the help of my physical therapist. It is the pain that I have been able to slowly diminish through diligent practice of the techniques I learned.
The inflammation/sharp nerve pain is the problem that I have felt more powerless against; but the lidocaine injections on top of everything else I have been trying have given me more hope and confidence that I can fight that pain too...and win!
Fair warning: Lidocaine injections are not a pleasant experience. Even though it is a very thin needle, they are injecting something directly next to a very unhappy nerve which, as you can imagine, hurts. But it only lasts about 5 minutes and gets easier as you go along because the entire area begins to go numb. I also understood that the pain lessens each time that you do it because your nerves are learning to fire only as necessary. The injections are also spaced further and further apart as you go because the nerve-caming action will last for longer periods each time (for example, you might go every 2 weeks, then every month, and then every 2 months and so on...). For anyone interested in how it is going, keep an eye on my case study since I'll be reporting there.
Couple things to keep in mind when you go for Lidocaine injections:
a) Bring a pad because I had a bit of bleeding and they said that this is very common.
b) I think it is best to try to find a doctor not too far away from you who is willing to do these. My appointment was over an hour away and I will have to go back at least once a month to continue getting the shots. It not only takes up the majority of a day to do this but I found that it was not great for my muscles to sit for such a long period of time right after I had these done.
I had a lot of luck with going home and doing the at-home massages that I talk about in the article titled "Deconstructing Physical Therapy" because it seemed that experiencing very intense pain stressed out my pelvic floor quite a bit. It seems as though catching it early would make it infinitely easier and faster to deal with.
Lastly, I'd like to propose another benefit to Lidocaine treatments: they are very accepted in the medical community so you most likely won't have a terribly hard time convincing your physician to let you try these (this is not something I can say very often so I don't think the importance of this statement should be overlooked!).
So, if you've previously discounted Lidocaine as a treatment, I hope that I've at least gotten you to consider veiwing it as one of the many options that can indeed help...even if it just buys you time to find the cause of your pain and find treatments that address the cause(s) directly.