A variety of treatment options may be presented to patients, including:1
Gentle care of the vulva can help provide pain relief:2,3
Vulvar pain can have an emotional or psychological aspect, and some women benefit from psychological counseling, sex therapy, or both. Referral for therapy does not mean that the pain is "all in the head." Sex therapy can provide education and information for individuals or couples. Psychological treatment can provide techniques for relaxation or coping with pain or an opportunity to explore other conditions that may relate to the pain.4 A randomized, controlled clinical trial found that women who had cognitive behavioral therapy reported a 30% decrease in vulvar pain that occurs with intercourse.5
Physical therapy and biofeedback also can be helpful for women with vulvodynia.6 Physical therapy for vulvodynia may include exercise, education, or manual therapies, such as massage, joint mobilization, or soft-tissue mobilization. Other methods of physical therapy can involve ultrasound, electrical stimulation, or biofeedback techniques.
Other complementary and alternative treatments, such as yoga7 and acupuncture,8 may be helpful in managing pain from vulvodynia, but there is little evidence about the effectiveness of these approaches.
Some patients find that following a diet that is low in oxalates, along with taking calcium citrate supplements, is helpful, although the evidence to support this approach is limited.9 Foods that are high in oxalates include greens, nuts, tea, chocolate, and soy products.10 Food high in oxalates may produce urine that is irritating, which contributes to the vulvar pain.11
Antidepressants, corticosteroids, and topical pain relievers have all been suggested for treatment of vulvodynia. However, the results of clinical research studies have not supported the use of these treatments. For example, NICHD-funded research found that amitriptyline (a tricyclic antidepressant) with or without topical triamcinolone (a corticosteroid used to treat skin conditions) was no more effective than self-management approaches (which included components of education and cognitive-behavioral, physical, and sex therapy) in managing vulvar pain, although the number of people in the study was small.12 Other NICHD-supported investigators conducted a randomized, controlled trial and found that oral desipramine (a tricyclic antidepressants) and topical lidocaine (an anesthetic), alone or in combination, were no better than placebos in helping women with vulvodynia.13
Research sponsored by the NICHD is evaluating the use of gabapentin, a drug that helps control epileptic seizures, for women with provoked vestibulodynia (or vulvar vestibulitis syndrome) in a randomized, controlled trial.14 The findings may also shed light on treating other chronic pain syndromes.
Surgery may be an option for women with severe pain from vulvar vestibulitis who have not found relief through other treatment options.15 A vestibulectomy (pronounced ve-STIB-yuh-LEK-tuh-mee) removes the painful tissue of the vestibule and may help relieve pain and improve sexual comfort. However, surgery is usually considered a last resort and is not recommended for women with generalized vulvodynia.16
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