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Vulvodynia

What's new

The British Association for Sexual Health and HIV (BASHH) has released new guidelines for managing vulval conditions, including vulvodynia. Suggested therapies include topical lidocaine (5% ointment or 1-2% gel) and amitriptyline (starting at 10 mg/day, titrating up to 75-100 mg/day). Other treatment options include gabapentin/pregabalin, pelvic floor muscle biofeedback, vaginal trainers, cognitive-behavioral therapy, transcutaneous nerve stimulation, and botulinum toxin injection. .

Guidelines

Key sources

The following summarized guidelines for the management of vulvodynia are prepared by our editorial team based on guidelines from the British Association for Sexual Health and HIV (BASHH 2025) and the European Academy of Dermatology and Venereology (EADV 2022).
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Medical management

Topical lidocaine
As per BASHH 2025 guidelines:
Consider offering topical local anesthetics, such as 5% lidocaine ointment or 1-2% lidocaine gel, daily for provoked vulvodynia. Counsel patients about possible irritation. Advise applying lidocaine for dyspareunia 15-20 minutes before intercourse and wash off just before.
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Consider offering a trial of topical local anesthetics, such as 5% lidocaine ointment or 1-2% lidocaine gel, for unprovoked vulvodynia. Consider offering regular application a few times throughout the day. Recognize the risk of systemic absorption with frequent application to large areas.
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  • Other topical therapies

  • Antidepressants

  • Anticonvulsants

Nonpharmacologic interventions

Lifestyle advice: as per EADV 2022 guidelines, advise lifestyle changes, as lifestyle factors including physical inactivity, stress, poor sleep, unhealthy diet, and smoking are associated with the severity and sustainment of chronic pain.
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  • Vulval care

  • Psychosexual interventions

  • Physical therapy

  • Acupuncture

Therapeutic procedures

Transcutaneous electrical nerve stimulation: as per BASHH 2025 guidelines, consider offering transcutaneous electrical nerve stimulation in patients with unprovoked
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or provoked vulvodynia.
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  • Botulinum toxin injections

  • Laser therapy

Surgical interventions

Vestibulectomy: as per BASHH 2025 guidelines, consider offering modified vestibulectomy in cases of provoked vulvodynia where other measures have been unsuccessful, recognizing that patients who have responded to topical lidocaine before intercourse may experience better outcomes.
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Follow-up and surveillance

Follow-up: as per EADV 2022 guidelines, obtain multidisciplinary long-term follow-up every 3 months until improvement.
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