200 Section - Quadruple Nerve Cryoneurolysis for Refractory Vulvodynia: A Case Study

Tuesday, May 19, 2026

6:00 PM - 7:30 PM PT

Presenting Author/Autor expositor(s)

AT

Adithi A. Tirumalai, BS

Medical Student
University of Central Florida College of Medicine
San Jose, California, United States

Co-Author/Coautor(s)

AK

Arun A. Kalava, MD

Assistant Professor of Anesthesiology
University of Central Florida College of Medicine
Tampa, Florida, United States

Case Diagnosis: Vulvodynia s/p Hysterectomy in 2020

Case Description: A 32-year-old female with a history of vulvodynia following a hysterectomy in 2020 had been treated for several years with conservative management, including topical therapies (Ketoprofen 20%, cyclobenzaprine 2%, lidocaine 10%), oral medications (Gabapentin, Cymbalta, Ketamine), and various nerve blocks (Genitofemoral, Pudendal, Posterior Femoral Cutaneous). Despite these treatments, her symptoms persisted, and she experienced significant distress. After prolonged trials of conservative treatments, she underwent quadruple nerve cryoneurolysis, which included the Right Pudendal, Ilio-Inguinal, Ilio-Hypogastric, and Genito-Femoral Nerves.

Post-procedure, the patient reported >80% pain relief, with sustained improvement over several months. Follow-up confirmed significant resolution of pain, without any new neurological deficits. The patient was able to return to ADLs and reported improved quality of life for 9 months.

Discussions: Vulvodynia is a chronic, debilitating pain condition affecting the vulvar area and is often resistant to conservative treatments. While nerve blocks have shown promise, the use of quadruple nerve cryoneurolysis as a treatment for vulvodynia is unprecedented. Cryoneurolysis, which uses extreme cold to target and disrupt nerve function, provides a novel approach to treating intractable vulvar pain. In this case, quadruple nerve cryoneurolysis led to dramatic post-surgical pain relief and sustained improvement.

Conclusions: This case highlights the transformative potential of quadruple nerve cryoneurolysis for patients with chronic and refractory vulvodynia, particularly for those who have not responded to traditional post-surgical management. The successful application offers a novel treatment modality that could be considered by PM&R specialists in similar cases of intractable neuropathic pain. Furthermore, this represents an important step in exploring advanced treatments and expanding the role of interventional techniques in the field, particularly in managing chronic pelvic pain syndromes. Further research is needed to evaluate the long-term outcomes of cryoneurolysis in this patient population, making this case a valuable addition to ongoing discourse in PM&R.