By Brenna Bagnell
This blog is a summary of our published article: Rosen, N. O., Dawson, S., Brooks, M., & Kellogg-Spadt, S. (2019). Treatment of vulvodynia: Pharmacological and non-pharmacological approaches. Drugs, 79, 483-493. https://doi.org/10.1007/s40265-019-01085-1
Vulvodynia is a chronic pain condition associated with discomfort around the opening of the vagina (vulva) that often interferes with sexual (e.g., penetrative sex) and non-sexual (e.g., sitting, exercise) activities. For more information on vulvodynia, see some of our other blog posts here, here, and here!
The development of vulvodynia is complex and not well understood, but evidence suggests that it stems from biological (e.g., genetics, inflammation, neurologic mechanisms), psychological (e.g., sexual function, mood), and social (e.g., interpersonal relationships) factors. The complexity of vulvodynia makes finding a “gold standard” treatment for those suffering from it challenging. As such, treatment providers must understand the range of options to offer people the approach that meets their needs.
What did we want to know?
We wanted to examine which pharmacological, non-pharmacological, or multimodal treatments were the most effective in treating vulvodynia.
Our aim was to provide medical professionals—as well as people with vulvodynia—with more information about what might be helpful.
What did we do?
We reviewed all existing research evidence for vulvodynia treatments.
What did we find?
The treatment approaches are divided into three types: (1) pharmacological, (2) non-pharmacological, and (3) multi-modal. Without getting into the nitty-gritty details of each treatment in this blog post, here are the most effective approaches for treating vulvodynia:
(1) Pharmacological
Studies have found that people with vulvodynia have a high pain sensitivity and more inflammation in the tissues surrounding the opening of the vagina [1-4].
This prompted researchers to explore pharmacological treatments prescribed both internally (e.g., medications) and externally (e.g., topical creams).
The following are some (but not all) of the potential pharmacological treatments:
-Antinociceptives such as topical lidocaine that numb the affected area.
-Anti-inflammatory products that reduce inflammation and swelling.
-Treatments that alter nerve activity, such as anti-depressants and anti-convulsants.
-Muscle relaxants, such as vaginal diazepam and Botox.
-Hormonal agents, like birth control.
Some pharmacological treatments may decrease pain symptoms such as antinociceptive agents that numb inflamed areas, anti-inflammatory agents, nerve altering medication (i.e., anti-depressants), hormones (i.e., birth control) and muscle relaxants. Unfortunately, many of the pharmacological treatments listed have only been tested in small studies and the evidence suggests that these treatments alone may not be the best treatment options.
(1) Non-Pharmacological
- Psychological interventions that reduce distress related to sex, increase sexual well-being and reduce pain. The most evidence-based treatment approach is cognitive behavioural therapy (CBT), which helps change unhelpful thoughts and increase coping skills [5]. CBT can improve the couple’s sexual function, satisfaction, and overall relationship.
- Pelvic floor physical therapy, which aims to strengthen and relax the pelvic muscles.
- Alternative approaches such as acupuncture, hypnosis, or laser therapy. Acupuncture may help to release endorphins and reduce pain [6]. Hypnotherapy may help alleviate pain and psychological distress associated with vulvodynia [7]. Laser treatments are not FDA approved, but some people who’ve used it report decreased pain during intercourse [8].
- A surgical procedure called a vulvar vestibulectomy which involves removing the painful areas of the vulva.
Non-pharmacological treatments such as psychological interventions (e.g., CBT), pelvic floor physical therapy, and vestibulectomies, are the treatment options associated with the most pain reduction, pain management and improved quality of life for women with vulvodynia.
(3) Multi-Modal:
Multimodal approaches to treating vulvodynia, involve a combined treatment plan. The most common multi-modal treatment method involves combining psychotherapy, pelvic floor physical therapy, and medication. For example, treatment providers may suggest women seek CBT, a pelvic floor physiotherapist, and utilize one of the pharmacological options described above.
Multimodal treatments may help decrease women’s pain, strengthen pain management skills and improve their overall well-being. Multimodal treatments require more randomized-controlled studies that help eliminate biases to better determine treatment effectiveness.
What does this mean?
Treatment outcomes for each option vary and people may experience pain reduction, while others may learn better pain management skills that improve their quality of life. We found that non-pharmacological treatments may be the best treatment option for people living with vulvodynia. Although people have experienced improvements with pharmacological and multi-modal approaches, more research is still needed in these areas.
Takeaways for Treatment Providers:
There are multiple options available for patient experiencing vulvodynia with varying outcomes. By knowing more about each treatment and its effectiveness, treatment providers can aim to provide better care based on each client’s specific experiences.
Takeaways for Individuals with Vulvodynia:
Despite having no “gold standard” treatment option, there are various treatments available to help manage the symptoms of vulvodynia. Although it may take some trial and error, with appropriate treatment, people and their partners can begin to experience improvements in their sexual well-being, psychological health, and overall quality of life.
REFERENCES
[1] Bohm-Starke N., Hilliges M., Brodda-Jansen G., Rylander E., & Torebjork E. (2001). Psychophysical evidence of nociceptor sensitization in vulvar vestibulitis syndrome, Pain, 94, 177–183. https://doi.org/10.1016/s0304-3959(01)00352-9
[2] Tympanidis P., Terenghi G., & Dowd P. (2003). Increased innervation of the vulval vestibule in patients with vulvodynia. British Journal of Dermatology, 148, 1021–1027. https://doi.org/10.1046/j.1365-2133.2003.05308.x
[3] Halperin R, Zehavi S, Vaknin Z, Ben-Ami I, Pansky M, & Schneider D. (2005). The major histopathologic characteristics in the vulvar vestibulitis syndrome. Gynecology and Obstetric Investigation, 59, 75–79. https://doi.org/10.1159/000082112
[4] Westrom L. V, & Willen R. (1998). Vestibular nerve fibre proliferation in vulvar vestibulitis syndrome. Obstetrics Gynecology, 91, 572–576.
[5] Bergeron S., Merwin, K., Dube, J., & Rosen, N. (2018). Couple sex therapy versus group therapy for women with genito-pelvic pain. Current Sexual Health Reports, 10, 79-87. https://doi.org/10.1007/s11930-018-0154-5
[6] Schlaeger, J. M., Xu, N., Mejita, C. L., Park, C. G., & Wilkie, D. J. (2015). Acupuncture for treatment of vulvodynia: A randomized wait-list controlled pilot study. The Journal of Sexual Medicine, 12, 1019-1027. doi: 10.1111/jsm.12830
[7] Pukall, C., Kandyba, K., Amsel, E., Khalife, S., & Binik, Y. (2007). Sexual pain disorders: Effectiveness of hypnosis for the treatment of vulvar vestibulitis syndrome: A preliminary investigation. The Journal of Sexual Medicine, 4, 417-142. https://doi.org/10.1111/j.1743-6109.2006.00425.x
[8] Murina, F., Karram, M., Salvatore, S., & Felice, R. (2016). Fractional CO2 laser treatment of the vestibule for patients with vestibulodynia and genitourinary syndrome of menopause: A pilot study. The Journal of Sexual Medicine, 13, 1915–1917. https://doi.org/10.1016/j.jsxm.2016.10.006
