Evaluation of a vaginal estrogenic cream in the treatment of induced vestibulodynia: double-insu randomized

Objective: Our objective was to assess the short-term effect of an estrogen cream on symptoms associated with provoked vestibulodynia. Methods: We undertook a double-blind randomized trial in women who had experienced dyspareunia satisfying the Friedrich criteria for at least three months. We compared the daily application of 3 g of vaginal cream containing 1.875 g of conjugated estrogens for six weeks (estrogen group) with the application of a comparable cream without estrogens (placebo group). The main outcome was modification of dyspareunia, determined by a visual analogue scale of pain from the pretreatment period to the post-treatment period. Secondary outcomes were colposcopic evaluation of the vulva and pain reported during the swab test. Results: Of 69 women randomized, 61 participated for the full duration of the trial. Dyspareunia was significantly lessened in both groups (estrogen group: 7.4 +/- 1.9 pre-treatment vs. 4.8 +/- 3.0 post-treatment, P < 0. 01; placebo group: 7.1 +/- 1.9 vs. 4.9 +/- 2. 7, P < 0.01), but the difference observed in terms of decrease between the two groups was not found to be significant (P = 0.5). Alternatively, the group treated with estrogen cream showed (1) a more substantial decrease of the pain reported at the orifices of the Bartholin's glands when palpated with a swab (P < 0.01), and (2) a decrease of the inflammation observed at the orifices of the Bartholin's glands orifices and the posterior fourchette (P < 0.01). Conclusion: Applying a vaginal cream, whether it contains estrogens or not, for six weeks lessens dyspareunia. Adding estrogens to such a cream could facilitate a decrease of the inflammation observed at the orifices of the Bartholin's glands and the vestibule.