Multimodal Tx for Vulvar Vestibulitis Studied


CHARLESTON, S.C. — A combination of intralesional steroids, antifungal therapy, and physical therapy may be effective for the treatment of vulvar vestibulitis syndrome, Carolyn Gardella, M.D., reported in a poster at the annual meeting of the Infectious Diseases Society for Obstetrics and Gynecology.

Of 21 women treated with intralesional steroids after failing treatment with topical steroids, 68% had complete resolution of symptoms, and all patients had at least 80% improvement.

Twelve of the 21 women also were treated with yeast suppressive therapy, and 14 underwent physical therapy for levator muscle hypertonus, noted Dr. Gardella of the University of Washington, Seattle.

Of the 12 women who also received yeast suppressive therapy, 10 (83%) had complete resolution of symptoms, but only 4 of the 9 (44%) who did not receive yeast suppressive therapy had symptom resolution, Dr. Gardella noted.

All patients were seen by a single clinician at a vulvovaginal specialty clinic during a 5-month period. A chart review showed that the women were symptomatic for a mean of 27 months before presenting at the clinic.

Eleven of the 21 had yeast by culture despite a lack of clinical evidence of yeast vaginitis, and all had failed treatment with 0.25% desoximetasone ointment applied twice daily for an average of 11 weeks.

The intralesional injections included 4-mg of betamethasone and 4 cc of 0.5% bupivacaine with epinephrine; the women received a mean of nine injections.

A randomized controlled trial of a regimen using intralesional steroids, antifungal treatment, and physical therapy for vulvar vestibulitis syndrome is warranted, Dr. Gardella wrote.

Her poster also indicated that the high prevalence of yeast by culture in the study population supports the “biologic plausibility” of empiric yeast suppressive therapy for women with vulvar vestibulitis syndrome.

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