Medical Treatment

Although topical pain relievers, corticosteroids, and antidepressants have all been suggested for treatment of vulvodynia, the results of clinical research studies do not support the use of these treatments. For example, NICHD-funded research found that amitriptyline (a tricyclic antidepressant) with or without topical triamcinolone (a corticosteroid used to treat skin conditions) was no more effective than self-management approaches (which included components of education and cognitive-behavioral, physical, and sex therapy) in managing vulvar pain, although the number of people in the study was small.1 Other NICHD-supported investigators conducted a randomized, controlled trial and found that oral desipramine (a tricyclic antidepressant) and topical lidocaine (an anesthetic), alone or in combination, were no better than placebo in helping women with vulvodynia.2 An expert panel, convened in 2016, recommended against the use of antidepressants or corticosteroids for vulvodynia.3

Research sponsored by NICHD is evaluating the use of gabapentin, a drug that helps control epileptic seizures, for women with provoked vestibulodynia (or vulvar vestibulitis syndrome) in a randomized, controlled trial.4 The findings may also shed light on treating other chronic pain syndromes.

Another treatment being tested is botulinum toxin, more commonly known as Botox injection, which is thought to work by causing temporary paralysis of the muscle cells in the pelvic floor.5 Current evidence regarding the efficacy of the treatment is mixed, and further clinical trials are needed.

Citations

  1. Brown, C. S., Wan, J., Bachmann, G., & Rosen, R. (2009). Self-management, amitriptyline, and amitriptyline plus triamcinolone in the management of vulvodynia. Journal of Women's Health, 18, 163–169.
  2. Foster, D. C., Kotok, M. B., Huang, L . S., Watts, A., Oakes, D., Howard, F. M., et al. (2010). Oral desipramine and topical lidocaine for vulvodynia: A randomized controlled trial. Obstetrics & Gynecology, 116, 583-593.
  3. Goldstein, A. T., Pukall, C. F., Brown, C., Bergeron, S., Stein, A., & Kellogg-Spadt, S. (2016). Vulvodynia: Assessment and treatment. Journal of Sexual Medicine, 13(4), 572–590.
  4. Brown, C. A controlled trial of gabapentin in vulvodynia: Biological correlates of response. NIH Project 1R01HD065740-01A1.
  5. Morrissey, D., El-Khawand, D., Ginzburg, N., Wehbe, S., O'Hare, P., & Whitmore, K. (2015). Botulinum toxin A injections into pelvic floor muscles under electromyographic guidance for women with refractory high-tone pelvic floor dysfunction: A 6-month prospective pilot study. Female Pelvic Medicine & Reconstructive Surgery, 21(5), 277–282.
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