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Topical Steroid, Antibiotic May Help Vulvar Vestibulitis.

SEATTLE -- Seventeen of 23 women with vulvar vestibulitis resolved tenderness and pain by alternately massaging in a topical corticosteroid and a topical antibiotic in a retrospective study.

The 74% response rate in this small study was equal to or better than response rates published for more invasive treatments, so this conservative approach deserves further study, Dr. Cherilyn A. White said at a meeting of the Society of Teachers of Family Medicine.

Dr. White of the Guthrie Clinic, Sayre, Pa., reviewed the charts of patients treated for vulvar vestibulitis by Dr. Barbara L. Wiseman, also of the clinic. Dr. Wiseman devised the combination therapy after anecdotally noting that either topical agent alone didn't help.

Dr. Wiseman instructed patients to apply a topical agent by massage to the tender points noted on physical examination, alternating 0.25% desoximetasone (Topicort) with one of two topical antibiotics, for at least six applications per day. After 1 week, they were to try to have intercourse using lubricants. Patients were seen for follow-up 2 weeks after initiating therapy.

For the topical antibiotic, Dr. Wiseman prescribed either 2.5% mupirocin (Bactroban) or erythromycin ophthalmic ointment at the initial visit. If a patient still had pain on intercourse after 2 weeks, Dr. Wiseman reviewed the technique for massaging in the topical agents; if the patient was applying them correctly, she switched to the other antibiotic. The choice of antibiotic did not appear to affect response rates, she reported.

Seven patients reported a recurrence of vulvar vestibulitis within 3 months after treatment. A repeat course relieved symptoms in all seven.

The success rate in this preliminary trial compares favorably with resolution of symptoms after cryotherapy (48%), perineoplasty (56%-80%), laser biopsy (7%-63%), and other invasive treatments used in previous studies, she said.

Dr. John W. Ely of the University of Iowa, Iowa City, said in his commentary on the study that he was astounded recently when he searched the literature to find a treatment for a patient with vulvar vestibulitis. "I just couldn't believe the invasive things that are suggested for this," he said.

Dr. Ely wondered which part of the regimen used in the study was beneficial: the corticosteroid, the antibiotic, the massage, or the physician's interest.

"I'm sure the massage had something to do with it--having [patients] actively doing something to help themselves," Dr. White said. She speculated that the three treatments--the two topical agents and massage application--worked synergistically.

The massage application used a circular motion, pursued to the point of discomfort but not pain. Dr. White described the technique using the soft tissue between the fingers on a hand as an example. "That's kind of what the tissue of the introitus feels like," she explained.

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Publication:Family Practice News
Article Type:Brief Article
Geographic Code:1USA
Date:Jun 15, 1999
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