(073) Dorsal Root Ganglion Stimulation for the Treatment of Persistent Clitorodynia

Abstract Introduction Clitorodynia, a localized form of vulvodynia, is characterized by chronic pain involving the clitoris. Prevalence rates are difficult to obtain but lifetime cumulative incidence of vulvodynia is 8%. Our current understanding of clitorodynia utilizes a region-based approach for assessing and treating this condition with region 1 being the end organ, region 2 is the pelvis/perineum, region 3 is the cauda equina, region 4 the spinal cord and region 5 is the brain. Success has been described with pharmacologic therapy, pelvic floor physical therapy, clitoral lysis of adhesions, and nerve blocks to name a few. In some cases, these fail to provide satisfactory relief. Dorsal root ganglion stimulation has demonstrated promise in managing chronic, focal neuropathic pain refractory to standard therapies. Objective To describe the clinical course and outcomes of a patient with refractory clitorodynia successfully treated with dorsal root ganglion stimulation, supporting its potential as a targeted and sustainable treatment option for genital pelvic dysesthesias. Methods A 43-year-old woman with a history of chronic hip pain and L5–S1 radiculopathy developed acute cauda equina syndrome. Unfortunately, she had a delay in treatment and underwent L5–S1 discectomy more than forty-eight hours after presenting symptoms. Although surgery partially relieved some of her symptoms, she subsequently experienced decreased sensation of bladder and bowel urgency, bilateral leg and foot paresthesia, and numbness at penetration with sex. Over the years, she developed intermittent clitoral pain with vulvar irritation. With time, clitoral pain became chronic. A region-based approach was utilized for evaluation and treatment. Treatments included pharmacologic management with gabapentin and pregabalin, clitoral lysis of adhesions, pelvic floor therapy, serial pudendal nerve blocks, serial dorsal nerve blocks, impar ganglion, caudal epidural, selective nerve root block, and radiofrequency ablation of the distal lumbar spine. These yielded only partial, short-term relief. Given persistent symptoms, she underwent a trial of dorsal root ganglion stimulation targeting the affected dermatomes. The procedure produced marked pain reduction, leading to permanent implantation. Results The patient reported immediate and sustained pain relief during the dorsal root ganglion stimulation trial, with significant improvement in sensory symptoms, mood, and overall quality of life. Compared with prior interventions, dorsal root ganglion stimulation provided durable improvement in both pain intensity and psychosocial functioning, without adverse events. Conclusions This case highlights the potential efficacy and safety of dorsal root ganglion stimulation for the management of clitorodynia refractory to conventional therapies. By allowing precise modulation of sensory input from the genital region, dorsal root ganglion stimulation serves as a promising therapeutic option for focal neuropathic pain. Further research through prospective studies and multicenter trials is warranted to establish patient selection, stimulation parameters, and long-term outcomes. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Dare Pharmaceuticals.