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. 2024 Aug 2:16:1337-1347.
doi: 10.2147/IJWH.S448861. eCollection 2024.

Vulvodynia, Genital Eczema and Lichen Sclerosus: What are the Successful Treatments from a Patient's Perspective?

Vera Christina Berger  1   2 , Ronja Fierz  2 , Isabel Kolm  3 , Brigitte Leeners  2   4 , Cornelia Betschart  1   2
Affiliations

Vulvodynia, Genital Eczema and Lichen Sclerosus: What are the Successful Treatments from a Patient's Perspective?

Vera Christina Berger et al. Int J Womens Health. .

Abstract

Background: Genital pain treatment regimens range from local or systemic pharmacological to non-pharmacological, manual and psychosexual therapies with poor to moderate evidence for their efficiency. The aim of this study was to evaluate the subjective therapeutic response (genital pain relief) of different treatment modalities for vulvodynia and the most prevalent other vulvar pathologies, chronic vulvar eczema and lichen sclerosus by means of a cross-sectional survey.

Material and methods: A questionnaire-based cohort study that included 128 vulvodynia, 116 eczema and 79 lichen sclerosus patients was used. All patients attended the vulvar clinic at the University Hospital of Zurich. The patients who had been treated were surveyed from January to October 2022, using a customized online questionnaire consisting of 37 questions on symptoms and treatment outcomes for guideline-recommended treatment modalities. The study was approved by the Cantonal Ethics Review Board of Zurich.

Results: Altogether, 41 patients with vulvodynia, 37 with vulvar eczema and 23 with lichen sclerosus returned the questionnaire. The three groups were similar regarding pain characteristics and comorbidities. All three patient groups reported having benefited from non-pharmacological treatment (improvement rate vulvodynia 54%; eczema 51%; lichen sclerosus 58%), from topical (55%; 55%; 75%) and from locally invasive (46%; 66%; 50%) treatments. Overall, there was no significant difference in subjective treatment outcome between non-pharmacological, locally invasive, and topical treatments for vulvodynia, eczema, and lichen sclerosus. However, the use of oral medication was reported to be significantly less effective (p-value 0.050).

Conclusion: In conclusion, we found that in the patients' perception, topical, invasive and non-pharmacological treatments, but not oral medications, are helpful for genital pain relief in women with vulvodynia, vulvar eczema, and lichen sclerosus. Therefore, we recommend an escalating therapy approach with first-line non-pharmacological treatments together with topical therapies.

Keywords: genital pain; patient reported treatment outcome; survey; therapy; vestibulodynia.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Distribution of overall therapy modalities with respect to the 2021 European Guidelines assessed groupwise (locally invasive, topical application, non-pharmacological, oral) for Vulvodynia, Eczema and Lichen sclerosus.
Figure 2
Figure 2
Overview of therapeutic success in a five-step ordinal order for Vulvodynia (a), Eczema (b) and Lichen sclerosus (c).
See this image and copyright information in PMC

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