(053) Low Intensity Shockwave Therapy in Patients with Vulvas with Sexual Dysfunction
Authors: Goldstein I , Yee A , Goldstein S W 
Published: May 2023

Abstract

Introduction
High intensity shockwave treatment has been used for kidney stone lithotripsy since the 1980’s; such devices generate an energy flux density (EFD) of approximately 0.9 mJ/mm2. Low intensity shockwave therapy (LiSWT) devices generate approximately one tenth of that EFD, 0.05 – 0.13 mJ/mm2. LiSWT was first used in sexual medicine in 2010 to treat erectile dysfunction (ED). In 2019 we began utilizing LiSWT for patients with vulvas with various sexual dysfunctions (SD).

Objective
To review our clinical uses of LiSWT as a non-hormonal, non-surgical treatment option for individuals with vulvas with various complaints of SD.

Methods
We have performed 324 total LiSWT treatment sessions, 1 to 17 total treatments per person, in 77 individuals with vulvas with SD; EFD (0.05 – 0.13 mJ/mm2), shocks (1800 – 4000/treatment), Hz 3, membrane pressure 1. The specific device used in our clinic, Softwave (TRT), is considered non-significant risk for human use by the FDA and cleared for pain amelioration, connective tissue activation, wound healing, and improved blood flow. This device has a parabolic reflective surface. For each underwater spark-gap discharge that generates a shockwave, there actually two shockwaves delivered: a primary unfocused shockwave and a secondary reflected focused shockwave. Each energy wave induces a variety of biologic reactions in tissues resulting from the mechanotransduction contraction/expansion forces produced.

Results
To date we have identified 4 clinical uses for LiSWT in our patients with vulvas (mean age 39 ± 21 years). Individuals with hormonally-mediated vestibulodynia (n = 12) or entrance dyspareunia associated with genitourinary syndrome of menopause (n = 13) have received a total of 61 (mean 5) and 64 (mean 5) vestibular treatment sessions, respectively. Positive outcomes from a sham-controlled randomized trial have been published for vestibulodynia. Our positive clinical experience in 60% (15/25) mirrors their data. This is especially important because not everyone is willing or able to undergo hormone treatment. Individuals with genito-pelvic dysesthesia from sacral radiculopathy (n = 22) have received 109 (mean 5) treatments directed to their lumbo-sacral region. These patients were either not candidates for spine surgery or continued to experience mild symptoms after spine surgery. LiSWT decreased or eliminated dysesthesia symptoms in 68% (15/22); a key predictor of success was the activation of radiculopathy symptoms (e.g. feet burning) during treatment. Finally, individuals who underwent LiSWT pre-operatively to reduce opioid use after complete vestibulectomy (n = 30) have received 90 (mean 3) vestibular treatments with a 65% reduction in opioid use with such prophylactic treatment. We have observed no serious and 2 transient adverse events, mild discomfort that resolved within several hours.

Conclusions
For individuals with vulvas with varying complaints of SD, LiSWT is a safe and effective non-hormonal, non-surgical treatment strategy. More research with LiSWT in this population is needed. A potential new clinical use for LiSWT is to manage stress/urge urinary incontinence (SUI) in a non-invasive, non-pharmacologic strategy.

Disclosure
No