Vaginal Diazepam Use With Urogenital Pain/Pelvic Floor Dysfunction

Serum Diazepam Levels and Efficacy Data

Donna J. Carrico, MS, WHNP; Kenneth M. Peters, MD

Disclosures

Urol Nurs. 2011;31(5):279-284. 

In This Article

Abstract and Introduction

Abstract

Introduction
Vaginal diazepam is used off-label for pelvic floor dysfunction and urogenital pain, but serum levels with efficacy have not been reported until now.
Methods
One clinician evaluated 21 women for overall, levator, and vulvar pain pre- and one-month post-daily diazepam treatment. One-month post-treatment assessments and serum diazepam levels were done.
Results
Sixty-two percent (62%) were moderately or markedly improved; 71% believed vaginal diazepam was "helping;" 24% "sometimes" helping; 1 had "no change;" none were worse. Overall mean pain decreased from 4.8/10 to 3.4/10. Combined levator mean score decreased from 3.8/10 to 1.8/10. Mean vulvar pain score decreased from 5.9/10 to 2.2/10; 71% used vaginal diazepam daily; serum diazepam levels less than or equal to normal (mean = 0.29, norm = 0.02 to 1.0 μg/ml). Only 33% reported mild drowsiness.
Conclusions
Vaginal diazepam may be helpful in treating pelvic floor/urogenital pain conditions. Larger, randomized-controlled research trials are needed.
Level of Evidence - Level VI (Melnyk & Fineout-Overholt, 2011)

Introduction

Many women present to a urology or gynecology practice with painful bladder syndrome/interstitial cystitis (PBS/IC) or vulvar pain that may be complicated by hypertonus of the pelvic floor. Chronic pain often motivates women to seek treatment; however, it is often difficult to discern the primary site of the pain. Traditional therapies may no longer be effective, especially if pelvic floor dysfunction (PFD) is present. Therapies targeting the pelvic floor hypertonicity may be more effective for these women. It has been noted that some clinicians order diazepam to be used off-label vaginally to relieve their patients' symptoms of pelvic floor dysfunction and interstitial cystitis (see Figure 1) (Brookoff, 2006; Butrick, 2009).

Figure 1.

Diazepam Pharmacologic Information Summary
Source: Thomson Reuters Healthcare, 2011.

A recent retrospective chart review of patients with high-tone pelvic floor dysfunction who used 10 milligrams of vaginal diazepam compounded suppositories at bedtime for 30 days in addition to other therapies report ed subjective improvement in 25/26 women and improved perineometery readings (Rogalski, Kellogg-Spadt, Hoffmann, Fariello, & Whitmore 2010). The usual dosage prescribed is 5 to 10 milligrams of diazepam tablets or compounded hypoallergenic suppositories or creams used vaginally up to three times a day. Anecdotally, pain relief has been significant, without the adverse effects common with the oral diazepam. This article presents results of one clinic population's use of diazepam vaginally off-label for PBS/IC, pelvic floor dysfunction, and/or vulvodynia.

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