Vulvar vestibular effects of ospemifene: a pilot study

The study aimed to assess the effects of ospemifene on vulvar vestibule in postmenopausal women with vulvar pain and dyspareunia. Fifty-five postmenopausal women used oral ospemifene 60 mg/d for 60 d. Symptoms of dryness, burning, and dyspareunia were evaluated on a 10 cm visual analog scale. Visual examination of the vulvar vestibule was also conducted. Patients also underwent current perception threshold (CPT) testing obtained from the vulvar vestibule. Fifty-five patients (94.6%) completed the treatment. Hot flashes were the most frequent adverse effects, but this led to a discontinuation of therapy in three patients (5.4%). After therapy, there was a statistically significant decrease from the baseline in the mean scores for dryness, burning, and dyspareunia and reduction of vestibular trophic score (baseline value of 11.2-4.2 after the therapy, p ≤ 002) and cotton swab test scores (2.81 compared with 1.25, p = .001). There was a difference in CPT values for all nerve fibers and more consistent for C fibers (-38% of sensitivity). These results confirm the efficacy of ospemifene on postmenopausal vestibular symptoms and signs; moreover, the drug was effective in normalizing vestibular innervation sensitivity.

Umbilical hypersensitivity in women with primary vestibulodynia

OBJECTIVE

To provide evidence that primary vestibulodynia (PV) is a congenital defect in tissue derived from the primitive urogenital sinus.

STUDY DESIGN

Twenty-two women with PV, 16 with secondary vestibulodynia (SV) and 8 controls were included in this study. Subjects underwent a complete history and physical examination, including assessment with a vulvalgesiometer to measure the sensory and pain detection thresholds in the vulvar vestibule, deltoid and umbilicus.

RESULTS

The median vestibular sensitivity was 5 g in the PV group and 10 g in the SV group (p= 0.77). The median umbilical pain thresholds for the PV, SV and control groups were 115, 675 and 500 g, respectively. Women with PV displayed a significantly higher level of umbilical sensitivity (a substantially lower pain threshold) compared with women with SV and the control group (p = 0.0001 and 0.002, respectively). There was no difference in umbilical sensitivity between the SV and control groups.

CONCLUSION

Because both the umbilicus and vulvar vestibule are derived from primitive urogenital sinus, this suggests that women with PV may have a congenital abnormality in urogenital - sinus-derived epithelium.