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Question answered:22/04/05 Warning! this question is over two years old.
Three clinical trials were found that examine the topical treatments of cromolyn cream capsaicin, lidocaine.
A prospective, double-blind, randomised, placebo controlled trial was conducted to assess the use of 4% cromolyn cream as a treatment for vulvar vestibulitis. Thirteen out of the 26 evaluable patients received cromolyn. “Patients in the cromolyn arm were more likely to have failed therapy with amitriptyline (p = 0.05), but the two groups were otherwise similar upon study entry. Overall, scores decreased from a median of 9 to 5 (p = 0.001) during the study, but the level of improvement was similar between both groups. Improvement was unrelated to duration of symptoms, fluconazole use, or sexual activity. Five patients (38%) taking cromolyn and six (46%) taking placebo felt they had a 50% or greater reduction in symptoms. In the 21 sexually active patients, the total score decreased from a mean of 12 to 8 (p = 0.005), but there was no statistically significant difference between study arms. Cromolyn cream did not confer a significant benefit in patients with vulvar vestibulitis. The large placebo response suggests the need for large well controlled studies of other treatment modalities.”
The trial on capsaicin (2) included 33 women with vulvar vestibular who were treated with topical capsaicin, which was applied twice daily for 30 days then once daily for 30 days, then 2 times a week for 4 months. The trial concluded that the response to treatment was partial, maybe due to the concentration of the compound being too low, or possibly a need for more frequent applications. The authors suggest: “The therapeutic role of capsaicin should hence be confined to a last-choice medical approach.”
A trial of 61 women with vulvar vestibulitis was conducted to assess the effectiveness of nightly application of 5% lidocaine ointment (3). “After a mean of 7 weeks of nightly treatment, 76% of women reported ability to have intercourse, compared with 36% before treatment (P =.002). Intercourse-related pain score was 39.11 (95% confidence interval [CI] 30.39, 47.83) points lower after treatment (P <.001), with a decrease of 10.37 (95% CI 3.53, 17.21) points in daily pain score (P =.004). We found no association between response to prior episodic use of lidocaine and response to nightly therapy with lidocaine ointment. Few patient characteristics predicted response to treatment; however, women with interstitial cystitis and other vulvar conditions were least likely to benefit.” The authors conclude that long-term, nightly application of 5% lidocaine shows promise as a treatment option for the management of vulvar vestibulitis, althought a randomized, double-blind, clinical trial is warranted.
- Nyirjesy P, Sobel JD et al. Cromolyn cream for recalcitrant idiopathic vulvar vestibulitis: results of a placebo controlled study. Sexually Transmitted Infections. 2001: 77(1);53-57
- Murina F, Radici G, Bianco V. Capsaicin and the treatment of vulvar vestibulitis syndrome: a valuable alternative? Med GenMed. 2004:6(4):48
- Zolnoun DA Hartmann KE, Steege JF. Overnight 5% lidocaine ointment for treatment of vulvar vestibulitis. Obstet Gynecol. 2003;102(1):84-87
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