[Evaluation of an estrogen vaginal cream for the treatment of dyspareunia: a double-blind randomized trial]. / [Évaluation d'une crème œstrogénique vaginale dans le traitement de la vestibulodynie provoquée : essai randomisé à double insu].

ABSTRACT

OBJECTIVE: Our objective was to assess the short-term effect of an estrogen cream on symptoms associated with provoked vestibulodynia. METHODS: We undertook a double-blind randomized trial in women who had experienced dyspareunia satisfying the Friedrichcriteria 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. RESULTS: Of 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 group7.1 ± 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). CONCLUSION: Applying 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.