Pharmacological Treatments for Localized Provoked Vulvodynia: A Scoping Review

Abstract

Introduction

Localized provoked vulvodynia (LPV) is a chronic pain condition without an identifiable cause that is localized to a portion of the vulva and provoked by pressure or touch. LPV is a commonly occurring but poorly understood condition lacking consensus on management.

Method

This scoping review used Arksey and O’Malley’s approach to identify and evaluate literature published between 2010 and 2023 that addressed the question: What is the current evidence on the efficacy or effectiveness of pharmacological treatments in the management of LPV?

Results

This review evaluated 18 papers reporting on the efficacy or effectiveness of oral, topical, and injectable medications. Seven of the studies were randomized controlled trials. Oral gabapentin and oral desipramine showed some improvement in sexual function compared to placebo. Small sample sizes and methodological issues limited confidence in interpreting findings. Pain was reduced in descriptive studies of tricyclic antidepressants, milnacipran, injectable anesthetics, and botulinum toxin. Where pain did not improve with treatment, some oral medications improved participants’ mood and sexual function. Some topical agents may be effective in reducing peripherally mediated neuropathic pain. Botulinum toxin was the most well-studied injectable but yielded mixed outcomes related to pain, quality of life, and sexual function.

Conclusion

There is a lack of convincing evidence to draw conclusions about the efficacy or effectiveness of pharmacological therapies for LPV. The breadth of therapies for treating LPV warrants the development of evidence-based, consensus guidelines for measuring treatment outcomes and improving comparisons across studies. Recommendations for research include addressing methodological shortcomings and diversifying the participant pool to increase the generalizability of findings.

Keywords:

• Localized provoked vulvodynia
• vulvar pain
• vestibulodynia
• vulvar vestibulitis
• vulva
• genitals
• medical treatment
• dyspareunia
• women

Acknowledgements

We gratefully acknowledge the contributions of Katherine Iannuzzelli, medical student at Rush Medical College in Chicago, IL, U.S. who contributed to the early stages of this project.

Disclosure statement

The authors confirm that there are no relevant financial or non-financial competing interests to report. All authors meet the ICMJE requirements for authorship.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.