IS THERE A PATH TO LASTING RELIEF? A REVIEW OF PHARMACOLOGICAL TREATMENT FOR VULVODYNIA
Abstract
Introduction: Vulvodynia is defined as discomfort of the vulva that lasts for at least three months and is clinically considered an idiopathic pain syndrome, presenting both diagnostic and therapeutic challenges.While non-pharmacological interventions such as pelvic floor physical therapy and psychotherapy provide relief for some patients, many require pharmacological treatment for persistent discomfort. Despite the availability of various pharmaceutical options, standardized treatment protocols are lacking, and comparative efficacy data remain limited. This review examines current pharmacological approaches for vulvodynia and assesses their effectiveness in managing symptoms.
Results: Following a rigorous selection process, 29 articles met the inclusion criteria. The available evidence supports the efficacy of oral medications, particularly amitriptyline as a first-line treatment, and topical lidocaine in managing vulvodynia. Furthermore, the integration of physiotherapy alongside pharmacological management appears to enhance patient outcomes. Botulinum toxin injections did not yield statistically significant improvement in the studies included in the review.
Conclusions: Amitriptyline and topical lidocaine have demonstrated efficacy for vulvodynia, particularly when combined with physiotherapy. Future research should focus on investigating the long-term efficacy of combined therapies and exploring the underlying mechanisms of vulvodynia to develop targeted treatments.
References
Bornstein, J., Goldstein, A. T., Stockdale, C. K., Bergeron, S., Pukall, C., Zolnoun, D., & Coady, D. (2016). 2015 ISSVD, ISSWSH and IPPS Consensus Terminology and Classification of Persistent Vulvar Pain and Vulvodynia. Obstetrics & Gynecology, 127(4), 745–751. https://doi.org/10.1097/AOG.0000000000001359
Harlow, B. L., Kunitz, C. G., Nguyen, R. H. N., Rydell, S. A., Turner, R. M., & MacLehose, R. F. (2014). Prevalence of symptoms consistent with a diagnosis of vulvodynia: Population-based estimates from 2 geographic regions. American Journal of Obstetrics and Gynecology, 210(1), 40.e1-40.e8. https://doi.org/10.1016/j.ajog.2013.09.033
Vieira-Baptista, P., Lima-Silva, J., Pérez-López, F. R., Preti, M., & Bornstein, J. (2018). Vulvodynia: A disease commonly hidden in plain sight. Case Reports in Women’s Health, 20, e00079. https://doi.org/10.1016/j.crwh.2018.e00079
Bornstein, J., Preti, M., Simon, J. A., As-Sanie, S., Stockdale, C. K., Stein, A., Parish, S. J., Radici, G., Vieira-Baptista, P., Pukall, C., Moyal-Barracco, M., & Goldstein, A. (2019). Descriptors of Vulvodynia: A Multisocietal Definition Consensus (International Society for the Study of Vulvovaginal Disease, the International Society for the Study of Women Sexual Health, and the International Pelvic Pain Society). Journal of Lower Genital Tract Disease, 23(2), 161–163. https://doi.org/10.1097/LGT.0000000000000461
Bajzak, K., Rains, A., Bishop, L., Swab, M., Miller, M. E., Logan, G. S., Jackman, V., Jackman, L., & Gustafson, D. L. (2023). Pharmacological Treatments for Localized Provoked Vulvodynia: A Scoping Review. International Journal of Sexual Health, 35(3), 427–443. https://doi.org/10.1080/19317611.2023.2222114
Goldstein, A. T., Pukall, C. F., Brown, C., Bergeron, S., Stein, A., & Kellogg-Spadt, S. (2016). Vulvodynia: Assessment and Treatment. The Journal of Sexual Medicine, 13(4), 572–590. https://doi.org/10.1016/j.jsxm.2016.01.020
Gupta, P., & Shekhar, C. (2016). Outcome of treatment of vulvodynia by local application of anaesthetic agent. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 1167–1170. https://doi.org/10.18203/2320-1770.ijrcog20160878
Eserdag, S., Akdag Özkok, B., Süphan Ersahin, S., & Zeynep Yilmaz, E. (2023). Vestibular hyaluronic acid injection in provoked vestibulodynia patients and its effect on pain and sexual function: A preliminary report. European Journal of Obstetrics, Gynecology, and Reproductive Biology, 280, 64–67. https://doi.org/10.1016/j.ejogrb.2022.10.027
Hedebo Hansen, T., Guldberg, R., & Meinert, M. (2019). Botulinum toxin-treatment of localized provoked vulvodynia refractory to conventional treatment. European Journal of Obstetrics, Gynecology, and Reproductive Biology, 234, 6–9. https://doi.org/10.1016/j.ejogrb.2018.12.013
Pelletier, F., Girardin, M., Humbert, P., Puyraveau, M., Aubin, F., & Parratte, B. (2016). Long-term assessment of effectiveness and quality of life of OnabotulinumtoxinA injections in provoked vestibulodynia. Journal of the European Academy of Dermatology and Venereology: JEADV, 30(1), 106–111. https://doi.org/10.1111/jdv.13437
Bardin, M. G., Giraldo, P. C., Lenzi, J., Witkin, S. S., De Mira, T. A. A., & Morin, M. (2023). Does the addition of electrical stimulation or kinesiotherapy improve outcomes of amitriptyline treatment for women with vulvodynia? A randomized clinical trial. International Urogynecology Journal, 34(6), 1293–1304. https://doi.org/10.1007/s00192-023-05454-z
Murina, F., Di Francesco, S., & Oneda, S. (2018). Vulvar vestibular effects of ospemifene: A pilot study. Gynecological Endocrinology: The Official Journal of the International Society of Gynecological Endocrinology, 34(7), 631–635. https://doi.org/10.1080/09513590.2018.1427717
Rothenberger, R., Jones, W., & MacNeill, C. (2021). Itraconazole Improves Vulvodynia in Fungus Culture-Negative Patients Post Fluconazole Failure. Sexual Medicine, 9(4), 100383. https://doi.org/10.1016/j.esxm.2021.100383
Close, A., Culha, M. G., Albert, V., & Valancogne, G. (2023). Exclusive manual perineal rehabilitation with lidocaine 2% gel in the treatment of provoked vestibulodynia: Results from a single-arm interventional study. International Journal of Impotence Research, 35(2), 157–163. https://doi.org/10.1038/s41443-022-00537-9
Murina, F., & Ghisalberti, C. (2023). Clinical Significance of Topical Spermidine Hyaluronate in Vestibulodynia: An Early Appraisal. Open Journal of Obstetrics and Gynecology, 13(12), 1974–1984. https://doi.org/10.4236/ojog.2023.1312167
Langlais, E.-L., Lefebvre, J., Maheux-Lacroix, S., Bujold, E., Fortier, M., & Bouchard, C. (2017). Treatment of Secondary Vestibulodynia with Conjugated Estrogen Cream: A Pilot, Double-Blind, Randomized Placebo-Controlled Trial. Journal of Obstetrics and Gynaecology Canada: JOGC = Journal d’obstetrique et Gynecologie Du Canada: JOGC, 39(6), 453–458. https://doi.org/10.1016/j.jogc.2016.10.011
Kopits, I., Krapf, J. M., Moss, C., Mautz, T., Holloway, J., Starsiak, L., Lorenzini, S., & Goldstein, A. T. (2024). A survey of patient tolerance and satisfaction with capsaicin for neuroproliferative vestibulodynia. Sexual Medicine, 12(1), qfae012. https://doi.org/10.1093/sexmed/qfae012
Bachmann, G. A., Brown, C. S., Phillips, N. A., Rawlinson, L. A., Yu, X., Wood, R., Foster, D. C., & Gabapentin Study Group. (2019). Effect of gabapentin on sexual function in vulvodynia: A randomized, placebo-controlled trial. American Journal of Obstetrics and Gynecology, 220(1), 89.e1-89.e8. https://doi.org/10.1016/j.ajog.2018.10.021
Brown, C. S., Bachmann, G. A., Wan, J., Foster, D. C., & for the Gabapentin (GABA) Study Group. (2018). Gabapentin for the Treatment of Vulvodynia: A Randomized Controlled Trial. Obstetrics & Gynecology, 131(6), 1000–1007. https://doi.org/10.1097/AOG.0000000000002617
Murina, F., Graziottin, A., Felice, R., & Gambini, D. (2017). Alpha Lipoic Acid Plus Omega-3 Fatty Acids for Vestibulodynia Associated With Painful Bladder Syndrome. Journal of Obstetrics and Gynaecology Canada: JOGC = Journal d’obstetrique et Gynecologie Du Canada: JOGC, 39(3), 131–137. https://doi.org/10.1016/j.jogc.2016.12.035
van Beekhuizen, H. J., Oost, J., & van der Meijden, W. I. (2018). Generalized unprovoked vulvodynia; A retrospective study on the efficacy of treatment with amitriptyline, gabapentin or pregabalin. European Journal of Obstetrics, Gynecology, and Reproductive Biology, 220, 118–121. https://doi.org/10.1016/j.ejogrb.2017.10.026
Morin, M., Dumoulin, C., Bergeron, S., Mayrand, M.-H., Khalifé, S., Waddell, G., Dubois, M.-F., & PVD Study Group. (2021). Multimodal physical therapy versus topical lidocaine for provoked vestibulodynia: A multicenter, randomized trial. American Journal of Obstetrics and Gynecology, 224(2), 189.e1-189.e12. https://doi.org/10.1016/j.ajog.2020.08.038
Goetsch, M. F. (2020). Severe Postmenopausal Genital Pain Treated Successfully With Prolonged Estrogen Therapy: A Case Series and Narrative Review. Journal of Lower Genital Tract Disease, 24(4), 405–410. https://doi.org/10.1097/LGT.0000000000000553
Noto, C., & Frost, E. A. M. (2010). Capsaicin for Pain Management and Its Potential In Other Medical Conditions Review and Update. Topics in Pain Management, 25(12), 1–7. https://doi.org/10.1097/01.TPM.0000384082.16268.cb
Murina, F., Felice, R., Di Francesco, S., & Oneda, S. (2018). Vaginal diazepam plus transcutaneous electrical nerve stimulation to treat vestibulodynia: A randomized controlled trial. European Journal of Obstetrics, Gynecology, and Reproductive Biology, 228, 148–153. https://doi.org/10.1016/j.ejogrb.2018.06.026
Meleger, A. L. (2006). Muscle Relaxants and Antispasticity Agents. Physical Medicine and Rehabilitation Clinics of North America, 17(2), 401–413. https://doi.org/10.1016/j.pmr.2005.12.005
Haraldson, P., Mühlrad, H., Heddini, U., Nilsson, K., & Bohm-Starke, N. (2022). Botulinum Toxin A for Provoked Vestibulodynia: 12 Months’ Follow-up of a Randomized Controlled Trial. The Journal of Sexual Medicine, 19(11), 1670–1679. https://doi.org/10.1016/j.jsxm.2022.08.188
Diomande, I., Gabriel, N., Kashiwagi, M., Ghisu, G.-P., Welter, J., Fink, D., Fehr, M. K., & Betschart, C. (2019). Subcutaneous botulinum toxin type A injections for provoked vestibulodynia: A randomized placebo-controlled trial and exploratory subanalysis. Archives of Gynecology and Obstetrics, 299(4), 993–1000. https://doi.org/10.1007/s00404-019-05043-w
Villa-Muñoz, P., Albaladejo-Belmonte, M., Nohales-Alfonso, F. J., Alberola-Rubio, J., & Garcia-Casado, J. (2023). Treatment of Vestibulodynia with Submucosal Injections of IncobotulinumtoxinA into Targeted Painful Points: An Open-Label Exploratory Study. Toxins, 15(8), 476. https://doi.org/10.3390/toxins15080476
Bhuiyan, J., Habeshian, K. A., Booser, A. C., Gomez-Lobo, V., & Dowlut-McElroy, T. (2023). Botulinum Toxin Injections as a Treatment of Refractory Vulvodynia in Adolescents: A Case Series. Journal of Pediatric and Adolescent Gynecology, 36(5), 497–500. https://doi.org/10.1016/j.jpag.2023.06.001
Weinschenk, S., Benrath, J., Kessler, E., Strowitzki, T., & Feisst, M. (2022). Therapy With Local Anesthetics to Treat Vulvodynia. A Pilot Study. Sexual Medicine, 10(2), 100482. https://doi.org/10.1016/j.esxm.2021.100482
Hong, D. G., Hwang, S.-M., & Park, J.-M. (2021). Efficacy of ganglion impar block on vulvodynia: Case series and results of mid- and long-term follow-up. Medicine, 100(30), e26799. https://doi.org/10.1097/MD.0000000000026799
Kim, R., Kelly, K.-L., Olson, M., & Nickel, J. C. (2018). Early experience with topical meloxicam and lidocaine combination for the treatment of vulvodynia. Canadian Urological Association Journal = Journal De l’Association Des Urologues Du Canada, 12(8), 252–255. https://doi.org/10.5489/cuaj.4976
De Leo, V., Governini, L., Ponchia, R., Recalcati, D., & Murina, F. (2024). Effectiveness of Combination of Tibolone and Lactobacilli Plus Lactoferrin in Postmenopausal Women with Vulvar Vestibular Pain: A Preliminary Report. Nutrients, 16(14), 2378. https://doi.org/10.3390/nu16142378
Ruoss, C. M., Howard, E. A., Chan, K., Stevenson, P. G., & Vancaillie, T. (2021). Topical treatment of vulvodynia, dyspareunia and pudendal neuralgia: A single clinic audit of amitriptyline and oestriol in organogel. Australian and New Zealand Journal of Obstetrics and Gynaecology, 61(2), 270–274. https://doi.org/10.1111/ajo.13292
Keppel Hesselink, J. M., Kopsky, D. J., & Sajben, N. L. (2014). Vulvodynia and proctodynia treated with topical baclofen 5 % and palmitoylethanolamide. Archives of Gynecology and Obstetrics, 290(2), 389–393. https://doi.org/10.1007/s00404-014-3218-4
Steinberg, A. C., Oyama, I. A., Rejba, A. E., Kellogg-Spadt, S., & Whitmore, K. E. (2005). Capsaicin for the treatment of vulvar vestibulitis. American Journal of Obstetrics and Gynecology, 192(5), 1549–1553. https://doi.org/10.1016/j.ajog.2004.10.626
Haraldson, P., Mühlrad, H., Heddini, U., Nilsson, K., & Bohm-Starke, N. (2020). Botulinum Toxin A as a Treatment for Provoked Vestibulodynia: A Randomized Controlled Trial. Obstetrics and Gynecology, 136(3), 524–532. https://doi.org/10.1097/AOG.0000000000004008
Views:
0
Downloads:
0
Copyright (c) 2025 Karolina Kasprzak, Małgorzata Kuczek, Aleksandra Wiśniewska, Stanisław Kasprzak, Zuzanna Rabczak, Julia Marek, Justyna Tasior
This work is licensed under a Creative Commons Attribution 4.0 International License.
All articles are published in open-access and licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0). Hence, authors retain copyright to the content of the articles.
CC BY 4.0 License allows content to be copied, adapted, displayed, distributed, re-published or otherwise re-used for any purpose including for adaptation and commercial use provided the content is attributed.
