Treatment of Secondary Vestibulodynia with Conjugated Estrogen Cream: A Pilot, Double-Blind, Randomized Placebo-Controlled Trial

Langlais, Eve‐Lyne; Lefebvre, J.; Maheux-Lacroix, Sarah; Bujold, Emmanuel; Fortier, Michel; Bouchard, Céline

doi:10.1016/j.jogc.2016.10.011

Cited by 12 publications

(11 citation statements)

References 27 publications

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“…If further treatment is warranted, there is low‐quality evidence for the following topical treatments that were shown to reduce pain in pre to posttest studies (without a control group): gabapentin cream, 28 amitriptyline cream, 30 amitriptyline with baclofen cream, 29 ketamine‐amitriptyline cream, 31 conjugated equine estrogen cream, 33 and estradiol/testosterone cream. 32 …”

Section: Discussionmentioning

confidence: 99%

“…Conjugated equine estrogen 33 and estradiol/testosterone cream 32 increase the elasticity, thickness, and moisture of the vulvar epithelium. In a small‐sample double‐blind RCT of 20 women with PV, 33 equine conjugated estrogen showed no reduction in dyspareunia compared with the placebo cream control group. In a retrospective chart review of estradiol/testosterone cream for premenopausal women with PV, 32 vulvar pain was reduced pre‐ to post‐treatment.…”

Section: Treatments For Vulvar Pain and Dyspareuniamentioning

confidence: 99%

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Evaluation and Treatment of Vulvodynia: State of the Science

Schlaeger

Glayzer

Villegas-Downs

et al. 2022

J Midwife Womens Health

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Vulvodynia affects 7% of American women, yet clinicians often lack awareness of its presentation. It is underdiagnosed and often misdiagnosed as vaginitis. The etiology of vulvodynia remains unknown, making it difficult to identify or develop effective treatment methods. The purpose of this article is to (1) review the presentation and evaluation of vulvodynia, (2) review the research on vulvodynia treatments, and (3) aid the clinician in the selection of vulvodynia treatment methods. The level of evidence to support vulvodynia treatment varies from case series to randomized controlled trials (RCTs). Oral desipramine with 5% lidocaine cream, intravaginal diazepam tablets with intravaginal transcutaneous electric nerve stimulation (TENS), botulinum toxin type A 50 units, enoxaparin sodium subcutaneous injections, intravaginal TENS (as a single therapy), multimodal physical therapy, overnight 5% lidocaine ointment, and acupuncture had the highest level of evidence with at least one RCT or comparative effectiveness trial. Pre to posttest reduction in vulvar pain and/or dyspareunia in non‐RCT studies included studies of gabapentin cream, amitriptyline cream, amitriptyline with baclofen cream, up to 6 weeks’ oral itraconazole therapy, multimodal physical therapy, vaginal dilators, electromyography biofeedback, hypnotherapy, cognitive behavioral therapy, cold knife vestibulectomy, and laser therapy. There is a lack of rigorous RCTs with large sample sizes for the treatment of vulvodynia, rendering it difficult to determine efficacy of most treatment methods. Clinicians will be guided in the selection of best treatments for vulvodynia that have the highest level of evidence and are least invasive.

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Section: Discussionmentioning

confidence: 99%

Section: Treatments For Vulvar Pain and Dyspareuniamentioning

confidence: 99%

Evaluation and Treatment of Vulvodynia: State of the Science

Schlaeger

Glayzer

Villegas-Downs

et al. 2022

J Midwife Womens Health

View full text Add to dashboard Cite

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“…49 Local application of conjugated equine estrogen cream significantly reduced dyspareunia assessed by the McGill Pain Questionnaire, in a study with a small sample. 50 There was no significant reduction in pain after botulinum toxin type A injections. 51,52 Studies presented in Table 5 that examined conservative vulvodynia treatments showed that physical therapy, 53 manual perineal rehabilitation with lidocaine gel, 54 somatocognitive therapy, 55,56 itraconazole treatment, 57 and the online ACT program 17 reduced pain intensity during sexual intercourse and/or during a variety of other activities that cause vulvar pain.…”

Section: Physical Therapymentioning

confidence: 92%

Individualized multidisciplinary therapy for vulvodynia

Penteado,

Bonduki,

de Araújo

et al. 2023

J of Obstet and Gynaecol

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ObjectiveThe main objective of this review was to develop strategies for individualizing multidisciplinary therapy for vulvodynia.MethodsWe conducted two literature searches; the first one focused on clinical trials assessing vulvodynia treatments published after the recommendations of the expert committee of the Fourth International Consultation on Sexual Medicine. The second search targeted studies identifying predictive factors and mediators of vulvodynia treatments, published from the earliest date to October 2022.ResultsBased on data from 55 relevant studies, we developed models of individualized multidisciplinary therapy targeting groups of women less responsive to multidisciplinary therapy (characterized by women with higher vulvar pain intensity, impaired sexual functioning, and vulvodynia secondary subtype) and to physical therapy, as an isolated treatment (characterized by women with increased pelvic floor muscle tone and vulvodynia primary subtype). Each individualized multidisciplinary therapy model comprises three components: psychotherapy, medical care, and physical therapy. These components provide distinct therapeutic modalities for distinct subgroups of women with vulvodynia; the women subgroups were identified according to the characteristics of women, the disease, partners, and relationships. Additionally, for women with provoked vestibulodynia who exhibit less benefits from vestibulectomy (such as those with higher levels of erotophobia, greater vulvar pain intensity, and the primary subtype) and encounter resistance to individualized multidisciplinary therapy, we suggest additional conservative treatments before performing vestibulectomy.ConclusionOur study is a pioneer in the development of models that allow the individualization of multidisciplinary therapy for vulvodynia and represents a significant advance in the clinical practice of gynecologists, physiotherapists, and psychologists.

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“…Studies carried out with estrogens only, on the other hand, provide contrasting opinions. While the work of Bazin et al 28 failed to prove a significant improvement in the symptoms after the application of a conjugated equine estrogen cream, Langlais et al 29 demonstrated a substantial improvement in superficial dyspareunia. In light of the evidence, vulvodynia provoked by CHC cessation would benefit from the application of either estrogen‐only or estrogen‐testosterone topical treatment, which could even be considered as first‐line therapy 1 .…”

Section: Pharmacologic Optionsmentioning

confidence: 99%

Vulvodynia: A practical guide in treatment strategies

Santangelo

Ruggiero

Murina

et al. 2023

Intl J Gynecology & Obste

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Vulvodynia is a debilitating condition characterized by chronic vulvar pain, with a detrimental impact on the patient's overall quality of life. Its etiology is multifactorial, but still in the process of being clearly outlined. Vulvodynia is not a single entity. It is a heterogeneous condition characterized by multiple triggers, making it challenging to define a reference standard for its treatment. In this manuscript we selected all articles including the following key criteria: “vulvodynia”. The primary outcomes observed included the resolution of chronic pelvic pain, dyspareunia and sexual satisfaction, psychological well‐being, and overall quality of life. Most pharmacologic treatments require further evidence to be recommended. On the other hand, non‐pharmacologic approaches such as psychotherapy, physical therapy, and surgery have received stronger support. This review summarizes pros and cons of adopting available treatments. Multimodal approaches should be introduced to improve patient outcomes. Further investigations are warranted to improve patients' quality of life.

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Treatment of Secondary Vestibulodynia with Conjugated Estrogen Cream: A Pilot, Double-Blind, Randomized Placebo-Controlled Trial

Cited by 12 publications

References 27 publications

Evaluation and Treatment of Vulvodynia: State of the Science

Evaluation and Treatment of Vulvodynia: State of the Science

Individualized multidisciplinary therapy for vulvodynia

Vulvodynia: A practical guide in treatment strategies

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