Capsaicin and the Treatment of Vulvar Vestibulitis Syndrome: A Valuable Alternative?

Filippo Murina, MD, Gianluigi Radici, MD, and Vanda Bianco, MD

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Materials and Methods

Thirty-three women affected by VVS took part in the study; they were informed about the study and gave their consent. Diagnosis was in accordance with Friedrich's criteria.[3] Cultures of the vagina for Candida, Trichomonas vaginalis, bacteria, Chlamydia trachomatis, mycoplasma, and ureoplasma were negative. Pap smear and colposcopic examinations were negative for human papillomavirus. Vulvoscopy indicated vestibular erythema in 29 women. All of the patients had previously undergone different topical therapies without success. The average age was 34.2 years (range, 21 to 55 years), and the average duration of the disease was 15.4 months (range, 6 to 36 months). Of the 33, 15 women were on oral contraception when VVS was diagnosed.

Treatment consisted of a cream preparation of capsaicin powder (0.05 %) in hydrophilic means with glycerine and wax. Since capsaicin is known to cause intense burning, a lidocaine + prilocaine cream was applied 20 minutes before the actual treatment. Patients were instructed to apply about 1/4 teaspoon of the cream to the vestibular area, twice a day for 30 days, then daily for an additional 30 days, and finally 2 times a week for 4 months.

Patients agreed to abstain from sexual intercourse for the first month of therapy. They were scheduled for follow-up examinations after 4, 8, and 16 weeks of treatment and subsequently every 6 months. At first visit and at each follow-up assessment, symptoms of irritation and burning were assessed on a visual analogue scale; dyspareunia was graded on a scale of 0 to 3, where 0 stands for absence of the symptom, 1 for mild pain, 2 for moderate pain, and 3 for severe pain that makes intercourse impossible. All of the women completed a follow-up program of at least 18 months.

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