From the Guidelines
Treating vulvodynia requires a multifaceted approach, and the most effective treatment often involves a combination of lifestyle modifications, topical treatments, and physical therapy, as evidenced by the most recent study in 2024 1. The treatment of vulvodynia should prioritize lifestyle modifications, including wearing loose-fitting cotton underwear, avoiding irritants like scented products, and using water-based lubricants during sexual activity. For pain management, topical treatments such as 2-5% lidocaine ointment applied 15-30 minutes before sexual activity or 5% lidocaine ointment overnight can provide relief, as suggested by previous studies 1. Some key points to consider in the treatment of vulvodynia include:
- The use of vaginal dilators, which may be beneficial for increasing vaginal depth and accommodation, and can help survivors discover what hurts and what does not in a nonsexual setting, as noted in the 2024 study 1.
- The consideration of vaginal estrogen, which has been shown to be effective in treating itching, discomfort, and painful intercourse in postmenopausal individuals, as evidenced by a study in 76 postmenopausal survivors of hormone receptor (HR)–positive breast cancer receiving aromatase inhibitor (AI) therapy 1.
- The potential benefits of vaginal androgens, such as DHEA, which can reduce dyspareunia in postmenopausal individuals, although safety data for the use of androgen-based therapy in survivors of hormonally mediated cancers are limited, as discussed in the 2024 study 1.
- The use of selective estrogen receptor modulators, such as ospemifene, which has been found to effectively treat vaginal dryness and dyspareunia in individuals with postmenopausal vulvar and vaginal atrophy, and may be considered for survivors without a history of estrogen-dependent cancers, as recommended by the panel in the 2024 study 1. Overall, the treatment of vulvodynia should be tailored to each individual, and may involve a combination of these approaches, with a focus on addressing both the physical symptoms and psychological impact of chronic pain, as emphasized by the most recent study in 2024 1.
From the Research
Treatment Options for Vulvodynia
The treatment for vulvodynia, also known as vulvar pain syndrome, is multifaceted and often requires a combination of approaches. Some of the treatment options include:
- General vulvar care
- Topical medications, such as amitriptyline, gabapentin, lidocaine, baclofen, and hormones 2, 3
- Oral medications, including tricyclic antidepressants and gabapentin 3
- Injectables
- Biofeedback and physical therapy, particularly pelvic floor physical therapy 4, 5, 6
- Dietary changes with supplementations
- Acupuncture
- Hypnotherapy
- Surgery, such as vestibulectomy for provoked vestibulodynia or surgical excision of the vulvar vestibule 5, 6
- Cognitive-behavioral therapy 4, 5, 6
Approach to Treatment
The approach to treating vulvodynia often involves a stepwise approach, starting with less invasive methods and progressing to more invasive options as needed 4, 5. A comprehensive assessment is necessary to understand the pain experience of women presenting with vulvodynia, and treatment should be individualized based on the patient's presentation and physical examination findings 6. Multidisciplinary treatment approaches are also recommended, but more studies are needed to determine which components are most important 5.
Challenges in Treatment
It is noted that no one treatment is clearly the best for an individual patient, and vulvodynia has many possible treatments, but very few controlled trials have been performed to verify efficacy of these treatments 2. Additionally, current studies have used wide dosing ranges, making it difficult to standardize therapy, and there is a limited number of randomized and placebo-controlled trials 3.