A Systematic Review of Intravaginal Diazepam for the Treatment of Pelvic Floor Hypertonic Disorder

Abstract

This systematic review evaluates the efficacy of intravaginal diazepam in treating chronic pelvic pain and sexual dysfunction associated with high‐tone pelvic floor dysfunction. A literature search was conducted in Medline and Web of Science, including articles from the database's inception to July 2019. The search identified 126 articles, and 5 articles met study inclusion criteria: 2 observational reviews and 3 small randomized, controlled trials (RCTs) evaluating intravaginal diazepam for high‐tone pelvic floor dysfunction. The 2 observational studies identified subjective reports of improvement in sexual function for a majority of women, 96% and 71%, in each study. However, there were no statistical differences between Female Sexual Function Index (FSFI) and Visual Analog Scale (VAS) scores for pain identified. One RCT found no significant changes between groups in median FSFI or VAS scores, and a second RCT found no significant changes between groups in 100‐mm VAS scores. The third RCT demonstrated that compared with placebo, treatment with transcutaneous electrical nerve stimulation and intravaginal diazepam for women with vestibulodynia and high‐tone pelvic floor dysfunction yielded significant differences in reduction of dyspareunia (P ≤ .05), ability to relax pelvic floor muscles after contraction (P ≤.05), and current perception threshold values at a 5‐Hz stimulation related to C fibers (P < .05), but no significant changes in 10‐cm VAS scores. Intravaginal diazepam may be helpful in women with a specific diagnosis of high‐tone pelvic floor dysfunction, but more and larger studies are needed to confirm these potential effects.

Topical Therapy for Vulvodynia: A Review of the Literature

“…In summary, the evidence for diazepam is equivocal. Noncontrolled studies showed mostly subjective improvement, but controlled studies failed to show a significant reduction in pain 17,46. Further, although vulvodynia and pelvic pain/hypertonia are related, 2 of these RCTs included patients without a specific diagnosis of vulvodynia.…”

“…Nonpharmacologic approaches include cognitive behavioral therapy (CBT), pelvic floor physical therapy, acupuncture, and biofeedback techniques, and surgical removal of the tissue that is the source of pain (partial vestibulectomy). [11][12][13][14] Pharmacologic therapies include such agents as gabapentin for neuropathic pain, 15 antidepressants for the antinociceptor properties of serotonin and norepinephrine, 16 antiinflammatories (corticosteroids and nonsteroidal anti-inflammatory drugs), muscle relaxants, 17 and hormonal therapy. 10 Many of these agents are employed in either oral or topical form.…”

Female Sexual Dysfunctions and Urogynecological Complaints: A Narrative Review

“…Pelvic pain syndromes, such as IC/PBS, vaginismus, vestibulodynia, persistent pelvic pain, irritable bowel syndrome, and endometriosis, are common urogynecologic contributors to hypertonic states [ 48 ]. Frequency, urgency, dysuria, urine retention, fecal retention, dyspareunia, and vaginismus are all indications of high-tone pelvic floor dysfunction [ 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 ].…”

“…The physical rehab therapy of pelvic floor muscles, using relaxing techniques, pelvic reinforcement and stabilization, biofeedback, and electrical stimulation, proves to be an efficient treatment for high tone pelvic floor dysfunction. Internal pelvic floor massage (Thiele massage) makes the administration of a vaginal expander to prepare for sexual penetration much easier [ 53 , 54 , 55 , 56 , 57 , 58 ]. Physical treatment [ 59 ] may also benefit from precoital analgesics, antispasmodics, and muscle relaxants [ 57 ].…”

“…Internal pelvic floor massage (Thiele massage) makes the administration of a vaginal expander to prepare for sexual penetration much easier [ 53 , 54 , 55 , 56 , 57 , 58 ]. Physical treatment [ 59 ] may also benefit from precoital analgesics, antispasmodics, and muscle relaxants [ 57 ]. Tender point release and/or trigger point injections are another biomechanical therapy for persistent pelvic pain and hypertonus of the pelvic floor muscles.…”