(085) Topical Capsaicin for Provoked Vestibulodynia
Authors: Krapf J , Kopits I , Starsiak L , Holloway J , Lorenzini S , Goldstein A 
Published: May 2023

Abstract

Introduction
Provoked vestibulodynia (PVD), occurs when pain is localized in the vulvar vestibule and triggered by any vestibular contact (sexual or otherwise). PVD is the most common form of vulvodynia and there is currently no approved treatment. Capsaicin cream is hypothesized to improve vestibular allodynia in patients with neuroproliferative PVD by binding to the vanilloid receptor (TRPV1) on the C- afferent nociceptors and thereby causing defunctionalization of the TRPV1. Although capsaicin has been utilized as a treatment for vulvodynia, very little is known about its effectiveness in improving vestibular pain and sexual function.

Objective
Investigate the therapeutic potential of capsaicin cream as treatment for PVD.

Methods
Patients who were prescribed 0.025% capsaicin compounded in VersaBase cream were identified in the electronic medical record through a search of physician-entered diagnoses and confirmed with a prescription list from a compounding pharmacy. Adult patients with documented vulvodynia were included. Female Sexual Dysfunction (FSD) was measured before and after treatment with the Female Sexual Function Index (FSFI) and Female Sexual Distress Scale-Revised (FSDS-R).

Results
Twenty-five patients responded to the follow-up questionnaire. Average age at presentation was 30 years (range 18-52 years). Self-reported ethnicity of the study population was 76% White, 4% Latina, 4% Asian, 4% Mixed, and 4% Middle Eastern, with no response from 8% of participants. After consistent daily usage, 80% of patients were able to tolerate capsaicin application for the full 20 minutes. Washing the cream off with cold water was helpful for tolerating capsaicin application for 72% of patients, and 8% of patients found applying a topical anesthetic such as lidocaine helpful. The median amount of time required to increase tolerance to the full 20 minutes was 1-2 weeks. On a VAS scale, the mean pain score while initially applying capsaicin was 8.96, and the median was 10. While 48% of patients found capsaicin improved their vulvar pain, 56% of patients would recommend capsaicin as a treatment for vulvar pain. The mean FSDS score was 35.96 at baseline compared to 25.09 at follow-up (p &lt; 0.0001). On a VAS scale, the mean self-reported vulvar pain score was 8.2 at baseline compared to 5.35 when using capsaicin consistently (p &lt; 0.0001). The mean FSFI pain domain score was 0.98 at follow-up compared to 2.45 at baseline (p = 0.005). While not statistically significant, the mean total FSFI score was 15.44 at baseline compared to 17.84 at follow-up.

Conclusions
Capsaicin cream is a promising treatment for PVD. Among patients who are able to tolerate consistent daily usage, capsaicin cream significantly decreases vulvar pain. Patients should be counseled that topical capsaicin is initially severely painful, even with the use of topical anesthetics such as lidocaine. Emotional distress and trauma were reported among patients who were not able to tolerate capsaicin application. However, patients who were able to tolerate capsaicin reported feeling “grateful” and “satisfied” with the treatment. Capsaicin cream should be considered for patients who have failed more conservative treatments and proper counseling regarding application should be reviewed.

Disclosure
No