Generalized unprovoked vulvodynia; A retrospective study on the efficacy of treatment with amitriptyline, gabapentin or pregabalin

Abstract

Objective: To describe patient characteristics of women diagnosed with generalized unprovoked vulvodynia (GUV) and to estimate efficacy and tolerability of treatment.

Material and methods: Retrospective observational study in 241 women who presented with GUV at three vulvar disease clinics in Rotterdam, The Netherlands during 1996-2013. Main outcome was efficacy of amitriptyline, gabapentin or pregabalin treatment.

Results: The median duration of symptoms was 24 months and median age 62 years (range 36-89). Most of the patients reported a burning sensation, often worsened by sitting, urinating or having intercourse. Treatment with either amitriptyline, gabapentin or pregabalin produced long lasting pain relief in 60% and temporary pain relief in 10%, while treatment was not successful in 30% of the patients. Around 30% of the patients had to stop their medication due to side effects. In 44 of the 241 (18%) women signs of vulvar dermatoses were present that could not explain the symptoms. These women experienced the same therapeutic efficacy as those without any visible abnormalities (chi-square goodness of fit p=0.49).

Conclusions: Amitriptyline, gabapentin and pregabalin produced long lasting pain relief in most of the women with GUV. The 2015 International Society for the Study of Vulvovaginal Disease nomenclature acknowledges the concomitant presence of vulvar dermatoses and vulvodynia. This enables treatment of both conditions simultaneously, a situation that occurs regularly according to our study. We advocate that women with symptoms of GUV, with or without the presence of vulvar dermatoses, receive a therapeutic trial with drugs such as amitriptyline.

Keywords: Amitriptyline; Generalized unprovoked vulvodynia; Vulvar dermatoses; Vulvar pain; Vulvodynia.