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Medications used to treat vulvar pain include topical, oral, and intralesional medicinal substances, as well as pudendal nerve blocks and botulinum toxin. Tricyclic antidepressants and anticonvulsants also can be used for vulvodynia pain control. Gabapentin is also used to: “treat adult neuropathic pain (nerve pain) caused by herpes virus or shingles (herpes zoster). Moreover, the Gralise brand of gabapentin is only indicated for the management of neuropathic pain; and the Horizant brand is used to treat nerve pain” [1]. PV is localized pain confined to the vulvar vestibule and vaginal introitus that is provoked or triggered by touch. 7, 8 Generalized vulvodynia is unprovoked or spontaneous diffuse pain of the vulva and may extend into the inner thighs and perineum. 7, 8 Terms used for PV are not standardized and include localized provoked vestibulodynia Studies have shown that the use of a topically applied gabapentin cream and estrogen cream can significantly reduce pain from this condition. An effective long-term treatment is essential as vulvodynia can cause severe discomfort and affect a woman’s ability to go about normal daily activities. Alongside psychosocial interventions and physiotherapy, pharmacological treatment such as oral gabapentin are used in the treatment of vulvodynia. Topical formulations of gabapentin have shown promise in animal models and case reports investigating its use in other pain conditions. We evaluated the efficacy of gabapentin, in an extended release formulation, in women diagnosed with localized provoked vulvodynia, defined as superficial vulvar vestibular pain that is provoked by touch, in a demographically diverse sample. Background: Vulvodynia is defined in this international consensus as persistent vulvar pain that occurs for >3 months without an identifiable cause and with several potential associated factors. At present there is no univocal consensus in the Anonymous; December 26, 2008; Neurontin (gabapentin) "Neurontin plus physical therapy for my previously unrecognized pelvic bone rotation has basically cured my vulvodynia, which also involved horrendous skin irritation (raw, bleeding skin) in the area between my clitoris and vagina. Tricyclic antidepressants should be considered for the treatment of vulvodynia. Selective serotonin reuptake inhibitors and gabapentin (Neurontin) should be considered for symptomatic relief of ments for vulvar pain (Table 1). In women who have Figure 1. The cotton swab is used to test for pain locations on the vulva. Testing starts at the thighs and moves medially to the ves-tibule. The vestibule is tested at the 2:00, 4:00, 6:00, 8:00, and 10: 00 positions. Each time the vestibule is touched if pain is present, Results: Between January 2001 and December 2006, 51 women with vulvodynia (19 or 37% with generalized vulvodynia, 32 or 63% with localized) were treated with 2% to 6% gabapentin. This new study showed that putting the Neurontin (Gabapentin) in a topical cream decreased pain by an average of 2/3, and decreased pain by over 50% in 80% of the women. The topical cream should be one that is not irritating when used vaginally. Boardman et al. conducted a retrospective study of women who presented to a vulvar clinic in the USA from 2001 to 2006 with chronic (duration 3 months or greater) vulvar pain without an identifiable underlying cause, who were treated with topical gabapentin. Three concentrations of creams, 2%, 4%, and 6%, were tested, commencing with the low Gabapentin 6% Vaginal Gel is a gel-like semisolid formulation, specifically designed for easy and controlled application in the vaginal area. This topical medication is primarily used to treat vulvodynia, a chronic pain condition of the vulva. Vulvodynia, or vulvar pain of an unknown cause, has a significant negative impact on a woman's health, self-esteem, relationships, quality of life, and work productivity. Women can have vulvar pain from a specific etiology, pain without an identifiable cause, or both. Although gabapentin is recommended and commonly prescribed for vulvodynia, its value in such cases is usually associated with complaints that have neuropathic components, such as dynamic allodynia. Gabapentin (Neurontin), though FDA approved for the treatment of the neuropathic pain of post-herpetic neuralgia, has not been studied in localized provoked vulvodynia, but is used for treatment and considered helpful. It is a gamma aminobutyric acid (GABA) analogue, which was synthesized to mimic this neurotransmitter. Data from the Arnold, et al. study (4) suggested that Gabapentin reduces the pain of fibromyalgia. If one of several treatable vulvodynia pain triggers is pelvic floor (levator) pain/dysfunction then treatment which reduces pelvic floor muscle pain to palpation may reduce vulvodynia pain overall. The literature review included an English language and human trial literature search through MEDLINE (1946-May 2018) using OVID and EBSCOhost, and Excerpta Medica (1974-May 2018) using EMBASE. Search terms included vulvar vestibulitis syndrome, vestibulodynia, vulvodynia, vulvar pain, provoked vulvar vestibulitis, and vulvodynia treatment
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