From the Guidelines
Vulvodynia treatment should involve a multifaceted approach, including topical treatments, oral medications, physical therapy, and cognitive behavioral therapy, with the goal of improving symptoms and quality of life. The most recent and highest quality study, published in 2024, suggests that pelvic physical therapy, vaginal dilators, and topical prescription medications such as vaginal estrogen, vaginal androgens, and ospemifene can be effective in treating vulvodynia and improving sexual function 1.
Treatment Options
- Topical treatments: 2-5% lidocaine ointment, amitriptyline cream (2%), or gabapentin cream (2-6%) can provide relief for painful areas 1.
- Oral medications: tricyclic antidepressants like amitriptyline, or anticonvulsants such as gabapentin or pregabalin may help manage neuropathic pain.
- Physical therapy: focusing on pelvic floor exercises is crucial for patients with muscle tension or spasm.
- Cognitive behavioral therapy: helps address psychological aspects of chronic pain.
Specific Medications
- Vaginal estrogen is the most effective treatment for vaginal dryness leading to sexual dysfunction and has been shown to be effective in treating itching, discomfort, and painful intercourse in postmenopausal individuals 1.
- Ospemifene, an FDA-approved selective estrogen receptor modulator, has been studied in several large trials and was found to effectively treat vaginal dryness and dyspareunia 1.
- Vaginal androgens, such as DHEA, can also be considered for vaginal dryness or pain with sexual activity, but safety data are limited, especially in survivors of hormonally mediated cancers 1.
Multimodal Treatment
Treatment typically requires 2-3 months before significant improvement occurs, and combining multiple approaches often yields better results than monotherapy. The condition involves complex neuroinflammatory mechanisms and central sensitization, which explains why multimodal treatment addressing both physical and psychological factors is most effective. A thorough discussion outlining the uncertainty and potential risks and benefits of each treatment option should be had with the patient 1.
From the Research
Treatment Options for Vulvodynia
The treatment for vulvodynia, a condition characterized by vulvar pain or burning sensation for more than 3 months without an identifiable cause, can vary and often involves a combination of approaches. Some of the treatment options include:
- General care measures
- Topical agents, such as amitriptyline, gabapentin, lidocaine, baclofen, and hormones 2, 3
- Oral medications, including tricyclic antidepressants and gabapentin, which are commonly used due to their ease of use and patient preference 3
- Injectable agents
- Psychological approaches, such as cognitive-behavioral therapy 4, 5
- Pelvic floor rehabilitation, including pelvic floor physical therapy 4, 5
- Surgery, such as surgical excision of the vulvar vestibule, which has high success rates for provoked vulvodynia 4, 5
Individualized Treatment
It is essential to note that vulvodynia treatment must be individualized based on the patient's presentation and physical examination findings 4. A comprehensive assessment is necessary to understand the pain experience of women presenting with vulvodynia, and treatment typically progresses from less invasive to more invasive options 5.
Multidisciplinary Approach
A multidisciplinary treatment approach, involving psychological interventions, pelvic floor physical therapy, and other treatments, may be effective in managing vulvodynia 5. However, more studies are needed to determine which components are most important and to standardize therapy 3.