4. Discussion
neuropathic pain, VBD, ’, hyperalgesia, dyspareunia, infections, vestibular hypersensitivity, pain, allodynia, burning/pain, allergies
DYSPAREUNIA, INFECTIONS, DYSFUNCTION, ALLERGIES
Our results showed the effectiveness of self-applied TENS in the treatment of VBD, with a significant reduction in burning/pain and dyspareunia. In addition, the average FSFI total and V-Q questionnaire scores were significantly lower after treatment. Furthermore, the improvement was more pronounced in the group of patients who underwent specific parameters of stimulation (frequency and pulse duration), according to our previous studies [As a non-invasive and non-pharmacological treatment, TENS has been used to treat many types of neuropathic pain [A different pulse duration in high- and low-frequency TENS could be a decisive factor for efficacy. Several studies involving TENS in neuropathic pain reported that the combination of high frequency (100 Hz or more) and short pulse duration (50–60 µs) works through a spinal effect that is related to ‘pain gate’ mechanisms, in which the stimulation of large-diameter Aβ non-noxious afferent fibers (conveying activity related to touch perception, etc.) inhibits central nociceptive transmission, consequently decreasing pain perception [Furthermore, there was an increase in β-endorphins in the bloodstream and cerebrospinal fluid in healthy subjects after administration of either high- or low-frequency TENS [It has been reported that repeated use of TENS at equal parameters (frequency and pulse duration) can produce analgesic tolerance, which may decrease its positive effects. In contrast, a modulated TENS that applies stimulation across a range of frequencies may prevent the development of tolerance to electrical stimulation [Most women with VBD described their pain as “hot”, “burning”, or “pricking”, that the vestibular area was sensitive to touch (e.g., during sexual intercourse or tampon use), and that the pain would be aggravated by rubbing [The pattern of VBD responses suggests sensory abnormalities in the form of evoked pain (e.g., hyperalgesia or allodynia), suggesting sensitization as a manifestation of neuropathic pain [A limitation of this study is the lack of a placebo and control group and follow-up without treatment, although placebo TENS was already compared with functional TENS in our previous randomized controlled trial on women with VBD with three months follow-up [It is becoming increasingly apparent that VBD is a summation and overlap of various trigger factors (infections, hormonal disturbances, allergies, genetic aspects, psychological vulnerability, and others) with weight and predominance varying from patient to patient, in which the common endpoint is vestibular hypersensitivity and pelvic floor hypertonic dysfunction. As a result, any single-approach management strategy may not be adequate for all women. TENS is usually administered to patients as an adjunct treatment for pain reduction and is not given as a sole treatment.