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Vulva Monologues: Topical Gabapentin and Vulvodynia

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November 2010

I shudder when I remember that summer. I was so frustrated with my body. I couldn’t understand what was happening. Newly engaged, and we couldn’t be intimate. Every time we tried, it ended in tears. My partner tried to be strong for us, to be positive, but I wanted him to be vulnerable, to show me he hurt too. I tried crazy things, like inserting yogurt and even garlic in an attempt to get rid of what I guessed might be a horrible yeast infection gone wrong. That ended up with me going to an emergency room with cramps and irritation, and a look from the doctor like I was going to be one of her stories (“I had this crazy patient who…”).  Vulvodynia isn’t just a yeast infection, and don’t put garlic anywhere near your vulva – they aren’t friends!

After months of waiting, I finally saw an OB-GYN with expertise in vulvodynia. She confirmed my diagnosis of provoked vulvodynia (also called vulvar vestibulitis). Her first course of treatment was a topical compound cream of lidocaine and gabapentin.

A 2008 study of 35 women with local and general vulvodynia women treated with topical gabapentin found that 80% had a 50% reduction in vulvar pain (Boardman et al., 2008). The benefit of topical application is that you avoid the body-wide side effects of taking a pill. If you are interested in a topical treatment, another option is topical amitriptyline and baclofen (an anti-depressant and muscle relaxant, respectively). A small retrospective study  that investigated this treatment found :  29% patients reported no or little (<30%) improvement, 18% reported moderate (30-60%) improvement, and 53% reported much (>60%) improvement (Nyirjesy, 2009).

Unfortunately for me, after 3 months there was no change in my pain (and no sex either). I also felt that the base cream was even causing some irritation around the outer labia. So, the journey to find an effective treatment continued…

Topical gabapentin in the treatment of localized and generalized vulvodynia.
Obstet Gynecol. 2008 Sep;112(3):579-85.
Boardman LA, Cooper AS, Blais LR, Raker CA.

Topical Amitriptyline-Baclofen Cream for the Treatment of Provoked Vestibulodynia

Journal of Lower Genital Tract Disease:

October 2009 – Volume 13 – Issue 4 – pp 230-236

Nyirjesy, Paul MD1; Lev-Sagie, Ahinoam MD2; Mathew, Leny MS1; Culhane, Jennifer F. PhD1

Open Letter to All Health Professionals Treating Clients with Fibromyalgia

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Open Letter to Health Providers

I usually never write a letter of complaint after I have a(nother) bad experience with a health provider. I just want to move on. In some cases I am afraid commenting will affect my treatment. In others I just feel disillusioned that it will make any difference.

I am coming up on my four year anniversary since diagnosis and I feel a sense of responsibility, that after all my experiences I should raise awareness about the basics of safe, competent, patient centered care. So I am posting a letter I wrote to an acupuncture clinic I tried last week, which was an epic failure, in the hope that a health provider out there reads it and learns a thing or two!

Good afternoon,

I would like to cancel my appointment next week. Treating chronic pain patients requires specific skills and I would like to pass on a few suggestions for improving your clients’ experience:

– after the acupuncture needles are put in place, inform the client how they can call for assistance if they need to. I was in significant pain because of the lying position I was in and could not get help during the last 10 min of waiting.

– inform the patient about each procedure beforehand, what it will be like and what the possible consequences might be. Sarah (name changed) asked if I would like to try cupping and after I agreed she began the treatment before explaining what it entailed. Furthermore, instead of testing one or two times she did it all over my back. Since then, I have had chronic headache, a pain flare and deep bruising. The definition of my condition is increased pain sensitivity so an experienced practitioner should have trialed the treatment on the first visit. I have had to see my physiotherapist to undo the muscle spasms caused by this treatment.

–  I was given a herbal remedy but the ingredients were not explained, nor were the benefits or possible side effects described. This is the equivalent of my doctor saying ‘here is a prescription’ without telling me what it is, why, or what it should do! I have a lot of sensitivities to drugs and supplements, and often need a  lower dose than normal but was not given an opportunity to discuss this in private.

All of these examples are ultimately a failure of patient-centred care – making the client feel like a person rather than a diagnosis –  and therefore,  I will not be returning to your clinic.

Sincerely…