Treatment for Vulvodynia
Vulvodynia is a syndrome of unknown etiology characterized by chronic vulvar discomfort that can result in both physical and emotional pain in the lives of affected women. Medical textbooks recognized Vulvodynia around the turn of the 20th century. This disease went unnoticed in society until a dramatic increase in the number of cases once again brought Vulvodynia to attention in the mid-1980’s. Although an estimated 150,000 to 300,000 women have Vulvodynia in the United States, very little is known about how this painful condition can be prevented, treated or cured.
Vulvodynia is a painful vulvar medical condition with many proposed etiologies and treatments. We describe two compounded pharmaceutical treatments of an elderly female with treatment resistant vulvodynia. The first treatment consisted of 4% cromolyn sodium, 2% Lidocaine USP, 4% Amitriptyline HCl USP, 0.25% Atropine Sulfate USP, and 2% Ketoconazole USP in a polyethylene glycol base. It merely increased the patient’s discomfort. The second treatment consisted of 0.25% Atropine Sulfate USP, 10% Ketoconazole USP and 10% Biotin USP as a combination in a cocoa butter base. It resulted in the full remission of the vulvodynia.
Treatment for vulvodynia
Treating the problem as a nerve pain syndrome with tricyclic anti-depressants, especially amitriptyline (usually started at 10 to 25 mg each night increasing to 50 to 75 each night if required), or gabapentin (starting at 300 mg day 1, then 300 mg twice on Day 2, 300mg three times on day 3, then increasing further according to response up to a maximum of 1.8 g per day) seems helpful. This may reduce the nerve pain as well as help the emotional distress that goes with it. The choice of medication and the dosage may only be arrived at after some experimentation, so your doctor will help with getting this right.
Identifying anything that could irritate the sensitive vulval area such as soap, shower gel, bubble bath, feminine wipes etc is very important. These possible irritants should then be excluded. Aqueous cream can be used as an alternative to soap for women who find it difficult to accept using water alone.
Vulvodynia Treatment and Prevention Tips
Try to avoid using soap in the genital area.
Wash new underwear before wearing.
Always rinse underwear thoroughly after washing to remove soap residue.
Wear only all-cotton underwear and loose clothing. Avoid wearing pantyhose.
Achieve and maintain and healthy body mass index (i.e., ratio of weight to height),
Eat a healthy diet that is abundant in freshly-caught, cold-water fish; rice; fresh, organic vegetables other than spinach and beets; fresh, organic fruits other than berries; and healthy fats.
Enjoy foods containing soy, as soy contains phytoestrogens, plant substances that can mimic some of the effects of estrogen on the body.
Topical treatments for vulvodynia include local gel anesthetics (such as lidocaine 2%) applied over the tender areas 5-10 minutes before sexual intercourse and estrogen cream (0.5 to 2 g) every other day intravaginally specially for perimenopausal women. Regional therapies are pudendal nerve block (usually with bupivacaine 0.5%), and pelvic floor muscle rehabilitation with or without biofeedback.
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