Treatment of Secondary Vestibulodynia with Conjugated Estrogen Cream: A Pilot, Double-Blind, Randomized Placebo-Controlled Trial.
OBJECTIVE
To assess the efficacy of conjugated equine estrogen cream in reducing dyspareunia associated with secondary provoked vestibulodynia.


METHODS
We conducted a randomized, double-blind, placebo-controlled trial that included women with secondary provoked vestibulodynia. Participants were randomly allocated to daily application of conjugated equine estrogen cream on the vulvar vestibule (estrogen group) or daily application of a similar placebo cream (placebo group). All patients were evaluated before and after eight weeks of treatment, using a visual analogue scale for superficial dyspareunia (primary outcome), the McGill Pain Questionnaire for superficial dyspareunia, the Female Sexual Function Index for sexual satisfaction, and vulvoscopy for vestibular erythema.


RESULTS
The targeted recruitment for this study was 44 women, but because of funding shortfalls recruitment was limited to 20 women. These 20 participants were randomly assigned to two groups of 10. Improvement of superficial dyspareunia on the visual analogue scale was not significantly different between the two groups (estrogen group: 27% improvement vs. placebo group: 3% improvement, P = 0.29). However, the use of conjugated equine estrogen cream was associated with a significant post-treatment improvement in superficial dyspareunia and in all three secondary outcomes (P < 0.05), whereas this was not the case with the use of placebo.


CONCLUSIONS
Daily application of conjugated equine estrogen cream to the vulvar vestibule could potentially reduce superficial dyspareunia in women with secondary provoked vestibulodynia, but a randomized trial with adequate statistical power will be required to demonstrate this.
Department of Obstetrics, Gynecology, and Reproduction, Faculty of Medicine, Université Laval, Québec City, QC.
Eve-Lyne
EL
Langlais
Department of Obstetrics, Gynecology, and Reproduction, Faculty of Medicine, Université Laval, Québec City, QC.
Jessica
J
Lefebvre
Department of Obstetrics, Gynecology, and Reproduction, Faculty of Medicine, Université Laval, Québec City, QC.
Sarah
S
Maheux-Lacroix
Department of Obstetrics, Gynecology, and Reproduction, Faculty of Medicine, Université Laval, Québec City, QC. Electronic address: emmanuel.bujold@crchudequebec.ulaval.ca.
Emmanuel
E
Bujold
Department of Obstetrics, Gynecology, and Reproduction, Faculty of Medicine, Université Laval, Québec City, QC.
Michel
M
Fortier
Department of Obstetrics, Gynecology, and Reproduction, Faculty of Medicine, Université Laval, Québec City, QC.
Céline
C
Bouchard
D000293:Adolescent; D000328:Adult; D004311:Double-Blind Method; D004967:Estrogens / Q000008:administration & dosage / Q000627:therapeutic use; D004966:Estrogens, Conjugated (USP) / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D006801:Humans; D017699:Pelvic Pain; D010865:Pilot Projects; D010919:Placebos; D011792:Quebec; D012725:Sexual Behavior; D014622:Vaginal Creams, Foams, and Jellies; D056650:Vulvodynia / Q000188:drug therapy*; D055815:Young Adult
D004967:Estrogens; D004966:Estrogens, Conjugated (USP); D010919:Placebos; D014622:Vaginal Creams, Foams, and Jellies
Women's health; dyspareunia; estrogen; randomized trial