More research is needed to determine whether antidepressants should be recommended for the treatment of vulvodynia pain, according to a study recently published in the Journal of Sexual Medicine.
Vulvodynia is a chronic pain or discomfort in the vulva, which includes the clitoris, the labia, and the opening of the urethra. Women with vulvodynia commonly feel pain, itching, burning, or stinging, often with no clear cause. Vulvodynia may be localized (affecting one particular area) or generalized (affecting the entire vulva). Triggers for vulvodynia pain include sexual activity, tampon insertion, and clothing. According to study authors, an estimated 7-16% of women suffer from vulvodynia. In addition to pain, many women experience emotional distress and relationship problems as a result of vulvodynia.
Antidepressants are often prescribed to treat vulvodynia based on research that suggests these drugs help with other chronic pain conditions that don’t have clear causes.
Researchers Raphael J. Leo, MA, MD and Seema Dewani, MBBS of the State University of New York at Buffalo School of Medicine and Biomedical Sciences conducted a literature review to determine how effective these drugs were when specifically targeted for vulvodynia. They considered the types of antidepressants used, the doses, the duration of antidepressant treatment, adverse effects, and the effect of any accompanying health conditions.
The researchers analyzed 13 studies, which included 2 randomized control trials, 1 quasi-experimental trial, 7 non-experimental studies, and 3 case reports. They categorized the quality of the studies as high, moderate, and low. Only 2 studies were classified as high or moderate quality.
The authors concluded that recommending antidepressants to treat vulvodynia has not been based on solid research. “The results of this review indicate that there is a dearth of well-designed studies and inconsistent findings across investigations for the utility of antidepressant pharmacotherapy in the treatment of vulvodynia,” they wrote.
They pointed out that most of the relevant research has been from non-experimental studies. This type of design makes it difficult to determine just how much antidepressants have helped women with vulvodynia. For example, some women find that their vulvodynia comes and goes. An observational study without placebo controls cannot show whether improvement is due to this “spontaneous remission,” to a placebo effect, or to the antidepressant.
The authors also noted that some women with vulvodynia have concurrent psychiatric issues, such as anxiety or depression, that can exacerbate symptoms. However, several of the studies reviewed excluded women with such issues, so it is difficult to tell whether an antidepressant would have helped these women.
Also, most of the studies focused on tricyclic antidepressants. The authors suggest that investigating other types of antidepressants – or other medications – might be worthwhile.
Healthwise via Wake Forest Baptist Health
(Last revised: April 26, 2012)
The Journal of Sexual Medicine
Leo, Raphael J., MA, MD and Seema Dewani, MBBS
“A Systematic Review of the Utility of Antidepressant Pharmacotherapy in the Treatment of Vulvodynia Pain”
(Full-text. First published online: September 13, 2012)