Évaluation d’une crème œstrogénique vaginale dans le traitement de la vestibulodynie provoquée : essai randomisé à double insu

Abstract

ObjectiveOur objective was to assess the short-term effect of an estrogen cream on symptoms associated with provoked vestibulodynia. MethodsWe 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. ResultsOf 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). ConclusionApplying 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.