Vulvodynia may be treatable with botulinum toxin injections

Key Points

Washington - In refractory cases of localized, provoked vulvodynia, botulinum toxin type A can be considered a therapeutic option, according to Jennifer MacGregor, M.D., of Washington Institute of Dermatologic Laser Surgery, Washington.

Diagnosing the condition

Localized provoked vulvodynia is the most common subtype and is usually triggered by sexual activity or tampon insertion. It can typically be localized by the patient and reproduced during physical exam.

Currently, no single effective therapy or consensus on treatment exists for vulvodynia. Often, the condition is treated with pain medication, antidepressants, acupuncture or surgery.

"Treatment has been really unsuccessful thus far," Dr. MacGregor says.

Dermatologists can play a primary role in the care of these patients. According to one study, 61 percent of patients referred to a tertiary vulvovaginal clinic for chronic vulvar pain had a clinically relevant dermatologic condition. Dr. MacGregor says many of her referrals for vulvodynia actually have a diagnosable inflammatory condition, such as lichen sclerosis or lichen planus. For those without a primary diagnosis, vulvodynia can be considered a possible cause.

Botox treatment

The studies in the literature using Botox (onabotulinumtoxinA, Allergan) to treat vulvodynia are conflicting.

"Botox is not successful in every patient, which could be for a variety of reasons. For those with localized, reproducible pain and spasm at the vaginal introitus, a small dosage of botulinum toxin A directly to the affected area to the vaginal introitus can alleviate discomfort," Dr. MacGregor says. "I have successfully treated two patients with this method. Patients' symptoms clear within two weeks, and they may not ever recur."

Both of the patients Dr. MacGregor treated for vulvodynia have not had any recurrence of symptoms, and one of these patients was injected nearly two years ago. The treatment appears to have interrupted the pain cycle, she says.

"This case and several other reports in the literature follow the same pattern, so patients may not have recurrence of symptoms," she says.