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.
Compounded Preparations
Gabapentin
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.
http://www.ncbi.nlm.nih.gov/pubmed/18757655
Diazepam
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.
http://www.ncbi.nlm.nih.gov/pubmed/22073898
Amitriptyline
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.
Baclofen
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.
http://www.ncbi.nlm.nih.gov/pubmed/24691823
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.
I was prescribed a compound cream of 2% Ketamine and 6% Gabapentin for vulvodynia. This cream made my condition worse. What ingredient is likely to cause this irritation?
Vulvodynia can be a frustrating condition to treat because certain drugs will help one woman but irritate another. In that particular compound, I would question the base cream or gel. Since commercial creams and gels often contain preservatives, they can be irritating if the patient suffers from vulvodynia. The base that I often recommend is methylcellulose 3% with water as the “wetting agent.” That way your odds of being irritated by the base are minimal. A gel made in this manner will only be stable for 30 days at a time.
i have had fibro and vulvodynia for 13 yrs rawness burning itching pain on labia minora and majora in addition to hemorrhoids i take po gabapentin but would a topical ointment help like topical doxepin gaba or nortriptoline i need some relief i have been suffering so long nothing really helps this is a terrible problem pls any advise tnks Joanna
Joanna
I wonder if your fiber and vulvodynia are related. I would recommend looking into Low Dose Naltrexone (LDN). You can learn more about LDN here. I was also invited to be a guest on a podcast recently regarding LDN. Feel free to take a listen and browse the LDN Research website. I think you may find the information on LDN really interesting. If you want to try it, give it at least 3 months to fully work.
Topical medications like Doxepin, gabapentin, nortriptyline, diazepam are great options. I would not recommend an ointment or a cream. I would recommend a preservative free methylcellulse gel as the base. That way you medication will only consist of the medications, methyl cellulose and water. It really limits the irritants. The trade off is stability of the compound, obviously, since there are no preservatives. The medication should still be stable for 30 days.
I have had vulvodynia for 40 years and, over the years, have tried many creams but everything burns and the condition gets worse. I have recently read that taking a topical cream of baclofen (5 percent) and palmitoyletharolaminde (400 mg) three times a day may help with this condition. I am not sure exactly what these are made up of and am a little hesitant on using them. Is there something else that you might suggest I use or do you think it would be beneficial to use the above mentioned.
Many thanks,
Diane
Diane
It is very hard to say what will and what will not work for individual patients. Medications like baclofen, gabapentin, diazepam, lidocaine, etc have all been used successfully. However, every patient is different. Some patients will experience burning with medications listed above. The best approach is to just try different vaginal bases to start. Try each base for about 14 days to see if they cause irritation. These bases will not help with your condition but at least you MAY be able to find a base that will not irritate you. From there, have your physician try adding one, single ingredient to the base at a time to see if you can tolerate it and to see if the medication gives you any relief. There is a lot of trial and error at first and, unfortunately, some patients will be doing well for a period of time and then all of a sudden have burning again. Then, the process of finding the irritant should start all over.
As for the palmitoyletharolamine, I am not familiar with this, but I did find the following study what showed promising results: