Vulvodynia is a condition characterized by chronic vulvar pain that may include a burning or itching sensation. The condition is not caused by an infection or acute injury but often to neurological pain. The pain can be exacerbated by certain movements that cause friction like with bike riding or sitting. Pain is generally least noticeable when lying down. Pudendal, ilioinguinal, or genitofemoral neuralgia is often the cause of vulvar pain that has no other detectable causes. Studies have shown that the use of a topically applied gabapentin cream and estrogen cream can significantly reduce pain from this condition. An effective long-term treatment is essential as vulvodynia can cause severe discomfort and affect a woman’s ability to go about normal daily activities.
Nerve Damage and Chronic Pain
The chronic pain of vulvodynia may be due to damage to the genitofemoral, ilioinguinal, or pudendal nerves or a combination of these. Most often it is due to some kind of injury from surgery in the groin area but sometimes the cause is unknown. The condition can not be detected with a biopsy and is not caused by an infection or inflammation. While neuropathic vulvar pain is common, it is less likely to be diagnosed as it does not present with any visible changes. Since this condition is not well-known among healthcare practitioners, other treatments are sometimes used that are not effective for this type of pain.
The effect of vulvar neuropathic pain on a woman’s quality of life can be severe. Women with vulvodynia may experience depression in addition to the daily pain of the condition. The pain can include sensations of burning, itching, soreness, and rawness. This pain may prevent a woman from having sex, exercising, working, and other physical activities. Even sitting for long periods of time can cause vulvar pain to worsen.
Procedures for treating vulvodynia have included nerve blocks and surgical techniques, some of which have high incidences of damage as a result of the procedure. The most frequently used treatments are medications that may include antidepressants, anticonvulsants like orally administered gabapentin, and local anesthetics. Since vulvodynia is a chronic condition, treatment usually needs to be continued indefinitely. Many women prefer a treatment with less systemic effects like a gabapentin topical cream. For menopausal women, an estrogen cream may also be an effective long-term treatment.
Gabapentin for Treating Neuropathic Pain
Gabapentin is an anticonvulsant drug that was first approved in 1993 and sold under the brand name Neurontin. It became available as a generic in 2004 and since then has continued to be prescribed for a variety of applications. Its primary use in oral form is to treat focal and mixed seizures. It does not cure epilepsy but with continued use can control seizures. It may also be used in oral form to systemically treat neuropathic pain. Many off-label uses for gabapentin have been demonstrated to be effective in small trials including treatment for diabetic neuropathy and postherpetic neuralgia.
For treating vulvodynia, gabapentin works by inhibiting pain signals that are sent from damaged neurons. The retrospective study that was published in Obstetrics and Gynecology showed that gabapentin cream was well tolerated and effective for women experiencing vulvodynia. About 80% of the women using the cream showed at least a 50% improvement in pain scores. The women also experienced an improvement in sexual functioning and most started having vaginal intercourse again after treatment.
Estrogen Cream for Treating Vulvodynia
Topically applied estrogen can help with some of the symptoms of vulvodynia. Estrogen is used to prevent the tissue of the vagina from becoming thin and dry and it can also work for external genitals. The use of estrogen cream can increase the thickness of tissue and reduce some of the discomfort that comes from the effects of decreased hormone production during menopause. Multiple strengths of estrogen cream that can be used to treat vaginal symptoms of menopause are available from our compounding pharmacy.
- Topical gabapentin in the treatment of localized and generalized vulvodynia.
- Genitofemoral neuralgia: adding to the burden of chronic vulvar pain.