Vaginal Diazepam Use With Urogenital Pain/Pelvic Floor Dysfunction

Serum Diazepam Levels and Efficacy Data

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


Urol Nurs. 2011;31(5):279-284. 

In This Article


Four women had been previously diagnosed with PBS/IC by a urologist specialized in female urology; they also had pelvic floor dysfunction on their initial examination. Nine women had vulvodynia upon initial examination, with 66% (n = 6) of these women also having pelvic floor dysfunction. Seven women had pelvic floor dysfunction upon initial examination without PBS/IC or vulvodynia, and one woman had chronic pelvic pain with no vulvodynia, pelvic floor dysfunction, or PBS noted. The average age was 40 years (range 22 to 61). Fifteen women used vaginal diazepam two to three times a day, with doses at least 8 hours apart. The other women used vaginal diazepam less than daily, and many used it only one to two times per week. One patient needed 10 milligrams diazepam every 8 hours for symptom relief, while 15 women used 5 milligrams of diazepam vaginally (see Figure 3). One woman used 2.5 milligrams, 4 milligrams, and 6 milligrams of diazepam vaginally, while three women used 2 milligrams diazepam vaginally for symptom relief. Women with vulvodynia and/or dyspareunia found it useful to use vaginal diazepam one hour before sexual intercourse to reduce pain or discomfort with sex.

Figure 3.

Frequency of Each Vaginal Diazepam Dose Used

On a patient self-reported weekly recording form (see Figure 2), 71% (15/21) of the women stated they "believed it was helping," while only five women said it "sometimes" helps, and one woman did not believe it was helping (she discontinued it after four doses).

Seventy-one percent (71%) of the women were daily users of vaginal diazepam and had serum diazepam levels done one month after the start of treatment. Their serum diazepam levels were well within the normal range (0.20 to 1.00 μg/ml), with levels ranging from less than 0.1 to 0.7, with an average level of 0.29. The highest serum diazepam level (0.7) was noted two hours after the last dose (5 milligrams). The woman on 10 milligrams three times daily for one month had a serum diazepam level of 0.16 (see Figure 4).

Figure 4.

Average Serum Diazepam Level by Dose of Diazepam Used

The revisit data analysis is missing two levator pain scores and one vulvar pain score since three women declined these examinations at their revisit appointment. From the initial examination to the one-month post-treatment revisit examination, VAS pain levels significantly decreased from 4.8 to 3.4 (see Table 1). Additionally, the average vulvar Q-Tip level decreased from 3.3 to 1.2. For those women with vulvar pain greater than 0 on their initial examination, their average vulvar pain level decreased from 5.9 to 2.2 one month after vaginal diazepam use. Overall the average levator pain (right and left combined) significantly decreased from 3.8 pre-diazepam to 1.8 post-diazepam (see Table 2).

Most women (67%) reported no adverse effect from the vaginal diazepam, with 33% reporting some drowsiness; dose adjustments were made as needed based on any side effects. Overall, 62% (13/21) were respond ers on the GRA as noted by their "moderately" (n = 8) or "markedly" (n = 5) improved responses. Seven women reported "no change," one was "slightly improved," and none stated they were worse.


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