Efficacy of intra-vaginal diazepam for pelvic floor hypertonic disorder: A systematic review and meta-analysis

Background

High-tone pelvic floor dysfunction (HTPFD) is a neuromuscular disorder characterized by involuntary spasms of the levator ani muscles, often resulting in pelvic pain, dyspareunia, and bladder or bowel dysfunction. It is frequently associated with syndromes such as vulvodynia, interstitial cystitis, and pelvic myofascial pain. Current treatment options, including pelvic floor physical therapy and pharmacologic interventions, have limited evidence supporting their efficacy.

Objective

To assess the effectiveness of intra-vaginal diazepam suppositories in reducing pelvic floor muscle tone and alleviating associated symptoms in women with HTPFD.

Methods

A triple-blinded, randomized, placebo-controlled trial was conducted per PRISMA guidelines and registered in PROSPERO. Women aged ≥18 years with EMG-confirmed HTPFD were randomized to receive either 10 mg of diazepam or placebo vaginal suppositories nightly for 28 days. Primary outcomes included changes in resting pelvic floor electromyography (EMG). Secondary outcomes evaluated sexual function, pain levels, and quality of life via validated questionnaires.

Results

Twenty-one women were enrolled; 14 completed the trial (7 per arm). No statistically significant differences were observed between groups in resting EMG readings or subjective symptom scores. Both groups reported minor, non-significant improvements in pain and quality of life.

Conclusion

Current evidence is insufficient to determine the efficacy of intra vaginal diazepam for high tone pelvic floor dysfunction. Further large, well powered randomized controlled trials are needed to clarify its therapeutic role.