Nov 14

Valium for your Vagina

courtesy beachtrek.fortunecity.com

Dyspareunia is the latin word for “pain with sex”. The true prevalence of women who have pain with sex is unknown, since many women believe the pain to be “normal” or something for which nothing can be done. Various conditions can contribute to the symptom, including vestibulitis (here I recommend a visit to my colleague Dr. Andrew Goldstein’s website on this difficult condition www.cvvd.org), interstitial cystitis (painful bladder syndrome), and endometriosis, for instance. Once the pain begins, the muscles of the pelvis, called the levator muscles (A.K.A. Kegel muscles and vaginal muscles) often spasm, creating a “TMJ of the vagina” type syndrome where everything hurts. The clenching of these muscles can be measured with a perineometer, a gadget that quantifies muscle tension during intentional contractions and at rest. In women with painful sex, the muscles often relax poorly, or not at all. Just like TMJ (temperomandibular joint/jaw pain), it’s important to be evaluated and managed by specialists with a track record of success. My colleague Andrew Goldstein (Washington DC and NYC) is one, and the authors of this fabulous paper, Susan Kellogg PhD and Kristene Whitmore, MD (Philadelphia) are two others. Susan and Kristene (www.sexandahealthieryou.org) are the authors of a timely paper recently published in the International Urogynecology Journal on management of this unhappy syndrome, the root of which includes Valium vaginal suppositories to relax the levator/Kegel/vaginal muscles. No joke. They work. Read a synopsis of the paper below:

Rogalski MJ, Kellogg-Spadt S, Hoffmann AR, Fariello JY, Whitmore KE. Retrospective chart  review of vaginal diazepam suppository use in high-tone pelvic floor dysfunction.  Int Urogynecol J (2010)21:895-99.

The authors review 26 charts of patients with levator hypertonus and sexual pain.  Evaluation included completion of the female sexual function Inventory (FFI) and visual Analog Scale of Pain (VAS-P). Levator muscle evaluation included perineometry and vaginal palpation exam.

21 women were premenopausal, 5 menopausal and 18 nulliparous. 85% reported dyspareunia, 81% chronic pelvic pain, 61% interstitial cystitis,  and 46% hypoactive sexual desire disorder.

Interventions included pelvic floor physical therapy, injection of trigger points with Traumeel and lidocaine, and 10 mg diazepam vaginal suppositories, inserted nightly for 30 days.

25 of 26 patients reported improved sexual function with 6 of 7 women who entered therapy abstinent due to pain resumed intercourse. Perineometry baseline muscle pressures decreased significantly, both at rest and post-voluntary contraction return to rest. Visual analog pain ratings decreased significantly for the majority of pelvic girdle muscles evaluated pre and post-therapy.

The authors propose that vaginal diazepam suppositories are a useful adjunct for the treatment of high – tone pelvic floor dysfunction, and announce plans to initiate a randomized crossover study from placebo to diazepam (valium) in newly diagnosed high-tone pelvic floor dysfunction patients.

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