Overnight 5% lidocaine ointment for treatment of vulvar vestibulitis.
OBJECTIVE
To assess the effectiveness of nightly application of 5% lidocaine ointment for treatment of vulvar vestibulitis.


METHODS
Over 17 months, we assessed women presenting to our pain clinic for evaluation of introital pain; 61 women met the criteria for vulvar vestibulitis and participated in a treatment trial. We measured daily pain and intercourse-related pain using a 100-mm visual analog scale. We compared ability to have intercourse and pain ratings before and after treatment, and investigated whether prior treatment or gynecologic comorbidities predicted response to treatment.


RESULTS
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.


CONCLUSIONS
Long-term, nightly application of 5% lidocaine ointment shows promise as a treatment for management of vulvar vestibulitis; a randomized, double-blind, clinical trial is warranted.
Zolnoun
Denniz A
DA
Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina 27599-7570, USA. denniz_zolnoun@med.unc.edu
Hartmann
Katherine E
KE
Steege
John F
JF
D000287:Administration, Topical; D000328:Adult; D015331:Cohort Studies; D016001:Confidence Intervals; D004334:Drug Administration Schedule; D004414:Dyspareunia / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage*; D008875:Middle Aged; D009824:Ointments; D010147:Pain Measurement / Q000187:drug effects*; D017060:Patient Satisfaction; D011336:Probability; D011446:Prospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014847:Vulvitis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*
D009824:Ointments; D008012:Lidocaine