Finding the Right Solutions for Vaginal Disorders through Compounded Medication

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Pain Relief for Women’s Health

Pain and discomfort from vaginal & vulvar conditions can be extremely uncomfortable and often requires medical intervention. It can affect women of different ages, sizes, and race all over the globe for various reasons. And other conditions like depression and anxiety can worsen the symptoms.

Some women may feel options are few when commercially available medications have not provided relief. Fortunately, compounded medication may help address a variety of vaginal disorders, especially those requiring customized medication.

Specifically, there are unique customizable options that compounding pharmacies can offer to patients with atrophic vaginitis, vulvar lichen sclerosis, desquamative inflammatory vaginitis, vaginismus, vulvodynia, and high-tone pelvic floor dysfunction.

Vaginal Atrophy

Also called atrophic vaginitis, it’s possibly the most common vaginal condition facing postmenopausal and perimenopausal women. Since the condition produces both urinary and vaginal symptoms, doctors refer to it as “genitourinary syndrome of menopause (GSM)” to describe vaginal atrophy and its accompanying symptoms:

  • Vaginal dryness
  • Vaginal burning
  • Vaginal discharge
  • Genital itching
  • Burning with urination
  • Urgency with urination
  • Frequent urination
  • Recurrent urinary tract infections
  • Urinary incontinence
  • Light bleeding after intercourse
  • Discomfort with intercourse
  • Decreased vaginal lubrication during sexual activity
  • Shortening and tightening of the vaginal canal

Source: Mayo Clinic

The usual route in addressing these symptoms is with intravaginal estrogen creams, gels and inserts (specifically estradiol). But this, unfortunately, is not the best therapeutic option for all women. A small clinical trial with compounded estriol showed promise in increasing estriol without increases in estrone or estradiol. While another study suggested that women who respond to estrogen therapy but are too sensitive to potent estrogens may benefit from compounded estradiol. In other words, compounded medication serves to ensure usefulness without overdosing.

Vulvar Lichen Sclerosus

In general, lichen sclerosus is a skin condition that causes itchy white patches on the genitals or other parts of the body. There’s no cure, but medication may help relieve the symptoms. Women over 50 are at higher risk. The back, shoulders, upper arms and breasts may also be affected. It’s possible to have mild lichen sclerosus with no symptoms. Symptoms may include:

  • Smooth discolored skin patches
  • Blotchy, wrinkled skin patches
  • Itching
  • Soreness or a burning feeling
  • Easy bruising
  • Fragile skin
  • Changes in the tube for urine flow (urethra)
  • Bleeding, blistering or open sores
  • Painful sex

Source: Mayo Clinic

More specifically, Vulvar Lichen Sclerosus (VLS) is characterized by atrophic, white plaques that cause pruritus, pain, burning, and potentially genital scarring and adhesion if not addressed successfully and early. In some patients, other areas such as the trunk, buttock, and thigh can be affected. High-dose topical steroids such as mometasone furoate 0.05% or clobetasol propionate 0.05% are the chief current ways in addressing the condition but there are other methods when those are not appropriate.

Naltrexone may be another compounded medication in topical form that may help. Because theoretically naltrexone works on suppressing the same overactive immune response as other autoimmune diseases it may successfully address.

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Vaginismus is an involuntary tensing of the vagina. People experience it at the start of sex, while inserting a tampon, or while getting a pelvic exam. These unintentional muscle spasms occur when something — a penis, finger, tampon, or medical instrument — attempts to penetrate the vagina. The spasms may be mildly uncomfortable or very painful.

Other symptoms of vaginismus include:

  • Not being able to have penetrative sex or insert a tampon at all
  • Fear of pain or sex
  • Loss of sexual desire


Source: WebMD

On the pharmacotherapy side, lidocaine 5% gel and lubricants have been used to help with painful vaginal intercourse. Combining lidocaine with a lubricant could prove to be a successful combination for patients dealing with this condition. Compounding ketamine 0.5% and amitriptyline 1–2% has been used to address genital pain and could be considered for patients who are unresponsive to other methods. In other words, compounded medication may positively affect the pain experienced by patients which may markedly improve their quality of life.

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Vulvodynia is chronic vulvar pain without an identifiable cause. While common, vulvodynia has multiple causes and makes practitioners uncomfortable to diagnose and address the condition because of the difficulty in truly identifying the cause. The symptoms, however, are mainly:

  • Burning
  • Soreness
  • Stinging
  • Rawness
  • Painful intercourse (dyspareunia)
  • Throbbing
  • Itching


Source: Mayo Clinic

The symptoms may be experienced either spontaneously or may be provoked by pressure to the vestibule for example, with:

  • sexual intercourse
  • tampon insertion
  • a gynecologic examination
  • prolonged sitting, and/or
  • wearing fitted pants


Source: National Vulvodynia Association

While the condition may have a psychological basis, compounded medication may help alleviate the pain involved. For example lidocaine 4% cream or gel applied to the vestibule prior to intercourse may reduce provoked pain in some patients. Gabapentin, ketamine, and amitriptyline have been used as well since these help with nerves and the pain response.
Another compounded solution, estriol 0.03% and amitriptyline 0.5% topical gel applied to the vulvar vestibule, was evaluated to be helpful by 51.2% of patients less than 30 years of age, 66.7% of patients 30–50 years of age, and 58.3% of patients over 50.

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Compounded Medication for the Right Solutions

Compounded medication and compounding pharmacists play an important role in helping women address painful conditions that significantly affect their quality of life.

Eastern States Compounding Pharmacy, being the first in New Hampshire, can assist practitioners and patients with addressing the symptoms and severity of vaginal conditions.

Eastern States Compounding provides quality compounded medications with its state-of-the-art facilities for sterile compounding, ensuring pure preparations.

Finding the right solution with compounded medication starts with a conversation. Feel free to ask our friendly pharmacists any questions you may have and contact us today.

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