Vulvodynia Treatment Options
In order to understand what the best approach for vulvodynia treatment is, we should first look at the causes of the condition. Unfortunately, this condition is poorly understood and vulvodynia treatment remains unclear. The pain associated with vulvodynia can last for months to years. The pain from vulvodynia can be so intense that sitting for long periods is nearly unbearable and just he thought of sex can be unimaginable. Vulvodynia can be a debilitating condition characterized by burning, stinging, irritation, or rawness around the vulva (the opening of the vagina). There are many different vulvodynia treatment options available. Some of the vulvodynia treatment options have been studied more than others.
Who Suffers from Vulvodynia?
The onset of vulvodynia typically occurs between the ages of 18 and 25. On average, 60% of women end up seeing 3 different providers before being diagnosed with vulvodynia. The other 40% of women will go undiagnosed. The areas affected by this condition can vary. Some women only experience pain in the vulva or genitalia. Other women will experience pain in multiple areas.
What Vulvodynia Treatment Options are Available?
Vulvodynia treatment options for this condition are many. Since we are a compounding pharmacy, I will focus on what we can do to help patients with vulvodynia. Other vulvodynia treatment options include seeing a physical therapist trained in treating pelvic floor muscle dysfunction. These exercises provided via the physical therapist can be very helpful in strengthening various muscles. Other vulvodynia treatment options include trigger point injections of steroids or Botox.
There is a lot of good research out there on the topical use of gabapentin 2-6%. In a study that appeared in Obstetrics & gynecology in 2008, women with vulvodynia were treated with 2% to 6% gabapentin. After a minimum of 8 weeks of therapy, the mean pain score among the 35 women was significantly reduced from 7.26 to 2.49. Overall, 28 of the 35 women (80%) demonstrated at least a 50% improvement inpain scores. Among patients with localized vulvodynia, sexual function improved in 17 of 20 women with evaluable results.
A study that was published by the Urologic Nursing Journal in 2011 evaluated the use of topical diazepam as a vulvodynia treatment. In this study, 21 women were given one diazepam 10mg suppository vaginally every night at bedtime. Sixty-two percent of these women were moderately or markedly improved and 71% believed that vaginal diazepam was “helping”. Only 33% reported mild drowsiness with this vulvodynia treatment.
Research is ongoing to determine if amitriptyline can suppress further outbreaks or reduce the incidence of postherpatic neuralgia. The Journal of Lower Genital Tract Disease published a study titled: Use of amitriptyline cream in the management of entry dyspareunia due to provoked vestibulodynia. This study concluded that topical amitriptyline cream should be considered for first-line treatment in the management of patients with provoked vestibulodynia causing entry dyspareunia. The response rate is reasonable (56%), and it eliminates the problems with systemic administration, namely, drowsiness and the difficulty patients have in accepting antidepressant medication for their condition. This could be a very promising preparation when it comes to vulvodynia treatment.
The Archives of Gynecology and Obstetrics published a study evaluating topical baclofen as a vulvodynia treatment. In this study a 33 year old womrn with intractable chronic vulvar and anal pain had to abstain from sexual intercourse and could neither cycle nor sit for more than 5 minutes at a time. The patient did not respond to standard treatments. The physician prescribed baclofen 5% and palmitoylethanolamide 400mg, three times daily. After 3 months her symptoms decreased more than 50% and sexual intercourse was possible gain without pain.
Hypoallergenic Gel Base
The base used for vulvodynia treatments (cream, ointment, gel, etc) is of the utmost importance. Many times creams are not a great option because of the preservatives. Sure, commercially available creams may not expire for 3 years but they could also cause severe burning. We have a great deal of success with a preservative free gel that we compound, in house, at PharmaCare Compounding Pharmacy. This does not contain any preservatives and therefore should not cause burning.