Insight into the treatment of vulvar pain: A survey of clinicians

The purpose of this investigation was to determine practice patterns among clinicians who frequently treat patients with vulvar pain syndromes. A cross-sectional survey was distributed to providers in the United States whose names were on a referral list of clinicians that care for women with vulvar pain (National Vulvodynia Association, Silver Springs, MD). The survey included 2 clinical vignettes. Clinicians were asked to report what treatments they would use to treat women with generalized vulvodynia and localized vulvodynia. Data were analyzed with descriptive statistics. A comparison of categoric data was accomplished with the Fisher's exact test. Surveys were mailed to 327 providers; 167 completed surveys were returned, for an overall response rate of 51%. The most commonly used treatment for vulvodynia was tricyclic antidepressants. There was no difference in the use of physical therapy, estrogens, injected or topical steroids, interferon, or laser therapy to treat generalized and localized vulvodynia. Respondents were more likely to use tricyclic antidepressants ( P < .001), gabapentin ( P < .001), and psychiatric care ( P < .001) and less likely to use local anesthesia ( P < .001) and vestibulectomy ( P = .007) for the clinical scenario that represented generalized vulvodynia than they were for the scenario that represented localized vulvodynia. Most clinicians reported screening for vaginal infections, and many clinicians perform colposcopy and/or vulvar biopsy. Respondents recommend a variety of lifestyle modifications in the treatment of vulvodynia. Clinicians use a wide variety of treatments for vulvar pain and use different therapies for variants of vulvodynia.