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Gabapentin enhances female sexual function
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Gabapentin improved sexual function in women with provoked vulvodynia, according to findings recently published in the American Journal of Obstetrics and Gynecology.
“We performed a secondary analysis on women who were enrolled in a study of gabapentin and [provoked vulvodynia] arm for sexual function overall and also analyzed changes in sexual function based on levator muscles pain severity,” Gloria A. Bachmann, MD, MMS, of the department of obstetrics, gynecology and reproductive sciences, at Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, and colleagues wrote.
They randomly assigned 89 women to receive either gabapentin or placebo.
Bachmann and colleagues found gabapentin was more effective in improving overall sexual function (adjusted mean difference, 1.3; 95% CI, 0.4-2.2) which included satisfaction (mean difference, 0.3; 95% CI, 0.04-0.5), arousal (mean difference, 0.3; 95% CI, 0.1-0.5) and desire (mean difference, 0.2; 95% CI, 0-3.3). However, sexual function stayed significantly lower compared with the 56 vulvodynia pain-free control patients and there was a moderate treatment effect among participants with baseline pelvic muscle pain severity scores above the median on the full Female Sexual Function Index (mean difference, 1.6; 95% CI, 0.3-2.8), pain domains (mean difference, 0.4; 95% CI, 0.02-0.9) and arousal (mean difference, 95% CI, 01.-0.5).
“These findings can assist the clinician in defining which patients with vulvodynia will benefit most from this intervention,” Bachmann told Healio Family Medicine.
“If the clinician and patient feel this is the best intervention after performing a benefit-risk assessment, clinicians could begin prescribing this gabapentin for painful intercourse immediately,” she added. – by Janel Miller
Disclosures: The authors report no relevant financial disclosures.
Perspective
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Mary Jane Minkin, MD, FACOG, NCMP
Vulvodynia is a very complex, poorly understood condition that affects as many as 9% of women. One of the major theories as to its cause is hypersensitivity of the nerves to the perineal region, referred to as pain afferents. This mechanism also underlies entities such as fibromyalgia and interstitial cystitis. Gabapentin is a drug well-known for blocking these nerves.
One of the first drugs used for vulvodynia was amitriptyline, which worked along a similar principle. Many women with vulvodynia have significant sexual issues that cause distress; the Female Sexual Function Index is a well-recognized, validated measure to assess these issues.
The major difficulty in the therapeutic use of gabapentin is the side effect profile. The dosage must be carefully titrated to minimize the side effects of sedation and bloating, which can prove quite bothersome to women with vulvodynia. However, if the patient is noticing improvement along the axes of pain and sexual distress, she will be more likely to continue with the regimen.
Bachmann is a well-recognized expert gynecologist who researches issues of pelvic pain. Her study shows some success with gabapentin in alleviating some of the distress from sexual issues for women with vulvodynia. The study is a multicenter study, further supporting the findings and thus, offers women with vulvodynia another therapeutic option which will hopefully improve their lives.
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