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Vaginal diazepam is used off-label for pelvic floor dysfunction and urogenital pain, but serum levels with efficacy have not been reported until now. One clin ician evaluated 21 women for overall, levator, and vulvar pain pre- and one-month post-daily diazepam treatment. One-month post-treatment assessments and serum diazepam levels were done; 62% were moderately or markedly improved. Levator examination pain scores were significantly improved, and vulvar pain scores decreased post-treatment. Serum diazepam levels were within normal limits. Vaginal diazepam may be helpful in treating pelvic floor/urogenital pain conditions.
© 2011 Society of Urologic Nurses and Associates Urologic Nursing, pp. 279-284, 299.
Key Words: Interstitial cystitis/painful bladder syndrome, pelvic floor dysfunction, pelvic pain, serum diazepam levels, vaginal diazepam, vulvodynia.
Many women present to a urology or gynecology practice with painful bladder syndrome/ interstitial cystitis (PBS/ IC) or vulvar pain that may be complicated by hypertonus of the pelvic floor. Chronic pain often motivates women to seek treatment; however, it is often difficult to discern the primary site of the pain. Traditional therapies may no longer be effective, especially if pelvic floor dysfunction (PFD) is present. Therapies targeting the pelvic floor hypertonicity may be more effective for these women. It has been noted that some clinicians order diazepam to be used off-label vaginally to relieve their patients' symptoms of pelvic floor dysfunction and interstitial cystitis (see Figure 1) (Brookoff, 2006; Butrick, 2009).
A recent retrospective chart review of patients with high-tone pelvic floor dysfunction who used 10 milligrams of vaginal diazepam compounded suppositories at bedtime for 30 days in addition to other therapies re - port ed subjective improvement in 25/26 women and improved peri neometery readings (Rogalski, Kellogg-Spadt, Hoffmann, Fariello, & Whitmore 2010). The usual dosage prescribed is 5 to 10 milligrams of diazepam tablets or compounded hypoallergenic suppositories or creams used vaginally up to three times a day. Anecdotally, pain relief has been significant, without the adverse effects common with the oral diazepam. This article presents results of one clinic population's use of diazepam vaginally offlabel for PBS/IC, pelvic floor dysfunction, and/or vulvodynia.
Background of the Problem
PBS/IC is currently defined as urinary frequency, urgency, and pain in the absence of other pathological causes or infections (Hanno, Keay, Moldwin, & VanOphoven 2005). Recently, a large...