A Topical Regimen for the Treatment of Provoked Vestibulodynia: Protocol and a Retrospective Case Series

Objective: The primary objective of this study is to describe the effectiveness of a topical treatment protocol for provoked vestibulodynia. The protocol is a 5-7 day trial of 5% lidocaine ointment, followed by a one to two week trial of 0.25% mg desoximetasone and 2% mupirocin ointments in those patients not responding to the lidocaine. As part of the treatment, patients also receive focused training regarding pain site identification and application of the ointments.
Methods: A retrospective chart review found 124 patients diagnosed with provoked vestibulodynia between August 2006 and January 2009 who were treated according to the treatment protocol. Extracted from the medical records was reported symptom improvement immediately following treatment and after a minimum 6 months follow-up.
Results: The majority of these patients had secondary provoked vestibulodynia with 56.5% reporting symptom(s) duration of greater than 1 year. The rate of positive response to the treatment protocol was 91%. The rate of positive response (90%) continued over a minimum six-month follow-up period, with 96.4% of the positive responders reporting persistent pain relief.
Conclusions: Topical overnight 5% lidocaine ointment alone or 5% lidocaine ointment followed by 0.25% mg desoximetasone and 2% mupirocin ointments alleviated symptoms of provoked vestibulodynia over a minimum 6 month follow-up in 90% of the subjects. Accurate patient identification of painful vestibular sites at the periurethral and posterior vestibular areas as well as patient education as to how to apply the ointments is critical component of this therapy.