Gabapentin (vaginal/pelvic use)

Also known as: gabapentin, Neurontin (branded)

Sexual Well-Being

In plain English

Gabapentin is a nerve-pain medicine. In compounded vaginal suppositories it is used to try to relieve chronic vulvar pain that can make sex painful. A well-run study of gabapentin for this condition did not show it worked better than placebo, so benefit is uncertain. It is generally used as part of a broader pain-management approach.

The science

Gabapentin binds the alpha-2-delta subunit of voltage-gated calcium channels, reducing excitatory neurotransmitter release and neuropathic pain signaling; the rationale for vulvar/vaginal use is treatment of the neuropathic component of vulvodynia. However, a multicenter, double-blind, placebo-controlled randomized crossover trial (Brown 2018) found extended-release oral gabapentin was not more effective than placebo for tampon-test pain, intercourse pain, or daily pain, and it did not improve sexual function—so the controlled evidence does not support gabapentin monotherapy for vulvodynia. Evidence for topical/vaginal gabapentin specifically rests on small uncontrolled series. Systemic gabapentin is FDA-approved for other indications (postherpetic neuralgia, seizures) and can cause dizziness/sedation; abrupt discontinuation is discouraged. Compounded vaginal gabapentin is off-label and not an FDA-approved formulation; efficacy for sexual pain is unproven.

References

• Brown et al., Obstet Gynecol 2018 (gabapentin for vulvodynia RCT)
• Brown et al., Am J Obstet Gynecol 2018 (gabapentin and sexual function, secondary analysis)