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chronic pain, pain, painful sex, pelvic pain

Vaginal Valium: another study shows it’s ineffective for pelvic pain

There are providers who recommend vaginal diazepam (Valium) for pelvic pain due to pelvic floor spasm. I have never understood why they do this as based on our understanding of how diazepam works it cannot be an effective therapy.

I have written previously about vaginal diazepam (Valium) here, reviewing that diazepam works on GABA receptors which are located in the central nervous system (brain and spinal cord) not the vagina. If women “feel better” after using the product vaginally it is either placebo effect or the fact that the diazepam is being absorbed into the blood stream and they are feeling the effects of diazepam on the brain. As diazepam is not recommended for chronic pain this latter effect on the brain is not a reason to  prescribe the drug.

A new study looked at 49 women with a hypertonic pelvic floor and pelvic pain. It is a small study, but sound. The women were randomized to 10 mg of diazepam vaginally or to placebo. Unsurprisingly, there was no difference in pain scores between the two groups.

There are now two randomized studies looking at vaginal diazepam (Valium). The other study is smaller with 21 enrolled women (full data on 14), but statistically and methodologically sound, and also showed no benefit from 10 mg diazepam vaginal suppositories. The only publication to show benefit was retrospective chart review of 26 patients with no placebo arm and the women received vaginal diazepam as well as physical therapy and trigger point injections, meaning a far lower quality study and one that by design could not test the benefit of vaginal diazepam. That 25 of 26 patients had improvement is no surprise as pelvic floor physical therapy is highly effective and retrospective studies have a significant degree of recall bias.

Whether this new study will stop the providers who prescribe vaginal diazepam and the physical therapists who advise their patients to ask for it remains to be seen.

A few years ago a colleague of mine was at a meeting where vaginal diazepam was recommended and when she spoke up that the neurobiology and pharmacology did not support its use she was met with a big “who cares?” and “some patients say it works.”

Some patients also think vaccines cause autism, but that doesn’t make it true. It is our job as medical professionals to do the right thing and prescribing a medical therapy that can’t work based biology, pharmacology and now two prospective clinical trials is not the right thing.

Two randomized, double-blinded placebo controlled trials tell us that vaginal diazepam doesn’t work for pelvic pain due to a hypertonic pelvic floor. This supports what we know about how the drug works. There are sadly few good quality prospective clinical trials in pelvic pain and so we do a great disservice to both our patients and to medicine when we ignore the few that do exist.

Not knowing what to offer is not a license to offer the wrong thing. Our patients deserve better than that.Screen Shot 2018-02-20 at 5.45.35 PM

 

 

 

Discussion

13 thoughts on “Vaginal Valium: another study shows it’s ineffective for pelvic pain

  1. Nice job done by Jen Gunter. She is doing her best to treat vagina related diseases. Men must appreciate for
    curing vaginas of their wives. They certainly get full pleasure while penetrating their penises into them.

    Posted by shakil ahmed | February 20, 2018, 7:01 pm
  2. I’ve heard of Rectal Diazepam for the treatment of acute epileptic seizures (good luck trying to give it Orally), but I wouldn’t attempt to shove it down my urethra if I had a pain in my penis!

    Posted by Peter Benson | February 21, 2018, 1:03 am
  3. “Not knowing what to offer is not a license to offer the wrong thing. Our patients deserve better than that.”
    So much this. See this every day in the children’s hospital – everyone wants a child to be better NOW even though there’s no good treatment option currently, and supportive therapy with watchful waiting is a perfectly viable option.

    Posted by JTD | February 21, 2018, 5:26 am
  4. Very interesting. Yeah, from a pharmacological standpoint it makes no sense whatsoever, and I think your analysis on why some patients feel better is spot on. I want to ask you about something I found on the net – dildos made from silver. To me, that sounds like a terrible idea because silver is bactericidal and that would mess up your vaginal flora…. but I’m not a gynecologist. What do you think?

    Posted by Asta Kask | February 21, 2018, 7:29 am
  5. Valium for vaginal health. Let’s see, now. Benzos like Valium are legitimately prescribed as muscle relaxants and for muscle spasm. Maybe that includes vaginal muscle spasm, as in vaginismus. Word on the street is that vaginismus can be a bitch. A less spased-out, less tense vagina will be a happy vagina. Aren’t we all for happy vaginas?

    Posted by david | February 21, 2018, 12:56 pm
    • Benzodiazepines are prescribed for acute muscle spasm and dystonias and then judiciously as they are highly addictive, cause falls, and withdrawal when improperly managed can be fatal. They are not for chronic pain or spasm, which is what vaginismus is. At this blog we are for evidenced based care, not evidence baseless care.

      Posted by Dr. Jen Gunter | February 21, 2018, 1:24 pm
  6. I don’t want no Valium in my tw@t, thank you.

    Posted by AssViolator | February 21, 2018, 6:43 pm
  7. I treat women with pelvic pain, and agree that there is poor evidence that vaginal valium works well. However, I have a handful of patients who swear by it. I also have pts who swear by urethral dilation for “urethral spasm”, which I think is a useless treatment. Treating pain is tough, especially to a population who thinks Google knows more than I do.

    Posted by Leah | February 22, 2018, 6:02 am
  8. It was Dr. Dan Bookoff who, years ago, introduced the concept of vaginal valium to the IC community. In fact, at the time of his death he was working on developing a branded one with the intention of bringing it to market. We, too, have patients who swear by their use especially after sex to prevent pelvic pain and/or IC flares. Given that AmiBac creams are often suggested for vulvar pain, I wonder if baclofen could be used vaginally to deliver a muscle relaxation effect? Love to hear your thoughts and thanks for the post. Very interesting.

    Posted by Jill | February 23, 2018, 12:46 am
  9. I was referred to this post by someone who concluded that if there’s a placebo effect you may as well go for it! Arggh. I’ve used diazepam with painkillers for vulvovaginal pain, and it’s not a good solution. I was desperate, my ex-partner kept on coercing me into very painful sex, and I know this is horribly common. I now go for proper stretches to help relax my pelvic floor, and have a loving partner rather than one who kept causing me pain. “Ditch your horrible husband” doesn’t go down well as advice, sadly.

    Posted by insearchofmornings | June 28, 2018, 3:32 am

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