Why use Capsaicin?
Capsaicin is a natural extract from chilli peppers. It is the part of the chili that gives the burning feeling in your mouth. So why would you put it on such a sensitive area as your vulva?
We all know how hot a curry can be. But we also know that people who eat curry every day get used to eating hot food and can eat chillis easily without discomfort. Their mouth becomes desensitized to the burning feeling.
Something similar happens when capsaicin (chilli) is put on painful vulval skin. The first time it is used, there is a sudden release of pain chemicals from nerves, and a strong burning feeling. However, over time, when used regularly, the nerves release less and less of the pain chemicals and the vulval skin becomes less sensitive.
What to consider before using Capsaicin cream
Many women have vulval pain, but only a few are suitable for this treatment. Capsaicin is one treatment option for women with Provoked Vulvar Vestibulodynia. This means a vulva that is painful to touch in an near the opening of the vagina, but where the skin looks completely normal and skin conditions of the vulva have been excluded. It will not help skin conditions such as lichen sclerosis, or candidiasis (thrush).
Treatment with Capsaicin is painful, and only for those who are determined, understand what is involved, and prepared to persist with treatment, even where this is painful.
Before trying capsaicin, it is ESSENTIAL that you see a gynaecologist, or vulval dermatologist (skin doctor) to make sure that all other causes of vulval pain have been excluded – and that easier ways of managing vulval pain have been tried.
Ensure that any dermatitis or dry skin has been treated. To do this, avoid washing the genitals with soap, and apply a liquid and soft paraffin product such as Dermeze 1% ointment (available at a pharmacy without a prescription) to the vulva three times a day for three weeks, to ensure that the vulval skin is in good condition.
How do I use Capsaicin?
Capsaicin (Zostrix) can be bought from a chemist without a prescription. It comes in 2 strengths – a milder 0.25% cream and a stronger 0.75% cream. We recommend that you start with the mild 0.25% cream. Allergy is capsaicin (chilli) is rare. It is a food most of us eat at some time.
It’s O.K. to ignore the instructions on the tube that say ‘do not apply to the genitals’, but be careful not to get Zostrix in your eyes, nose or mouth.
Get yourself into a comfortable position lying down on your bed, with a fan on, angled towards the vulva, and a selection of distracting activities (book, music, TV etc ready). It is important to be prepared, as once Capsaicin cream has been applied, pain is MORE severe when you move, and LESS severe when fanned with air. You will not want to move once the cream is applied.
Put on gloves, such as the thin gloves available in supermarkets for food preparation, and apply a thin layer of cream to the area of vulval skin where you have pain. Briefly and gently rub it into the skin. This causes a pain that feels deep in the tissues, rather than on the surface of the skin.
The burning capsaicin feeling is strong for approximately 20 minutes, moderately strong for approximately 40 minutes and then fades. The first application is usually the worst, and with each daily application you should find that your vulval pain becomes a little less.
Some women use the cream at night and wash the cream off in the morning. This is ideal if you are single (so your partner doesn’t come in contact with the cream), or can drift into sleep once the pain reduces. Others apply the cream and wash it off in the shower after 30-60 minutes.
It is wise to wash your hands before touching children or other people – and to wash the cream off your vulva before sexual contact with your partner.
How long should I use the cream for?
Use the cream once a day for 4-6 weeks to reduce the vulval pain. It should then be used as often as needed to prevent the vulval pain returning. This varies from person to person but might be once a week, or once a fortnight. If you choose to use the cream long term, you may prefer to use the stronger 0.75% cream.
Capsaicin cream does not cure the pain of provoked vulvar vestibulodynia – but when used regularly it can reduce it substantially.
If you have any concerns, please discuss these with your doctor.