| Category or mechanism | Specific medications or classes of medications | Comment |
| Medications that may induce vulvovaginal atrophy |
| If menopause is induced, vaginal atrophy will result. If the effect is temporary, these changes will reverse when the medication is discontinued. Some chemotherapeutic agents result in premature ovarian failure. In premenopausal women, tamoxifen has an anti-estrogenic effect on the vaginal epithelium, resulting in atrophy[1]. In contrast, in postmenopausal women, tamoxifen has an estrogenic effect on the vaginal epithelium. This results in increased vaginal discharge. Some postmenopausal women who are taking tamoxifen develop recurrent candidal vulvovaginitis, with resultant dyspareunia. Depot medroxyprogesterone acetate suppresses the hypothalamic-pituitary axis, which induces hypoestrogenism and vaginal atrophy. |
| Oral contraceptives | Some data suggest that oral contraceptives are associated with vestibulodynia. The mechanism of this is unclear[2]. These findings have not been investigated for other formulations of estrogen-progestin contraceptives (patch, vaginal ring). | |
| Anticholinergics |
| May result in vaginal dryness and dyspareunia. |
| Medications that increase the risk of recurrent candidal vulvovaginitis |
| Candidal vulvovaginitis is associated with the development of vulvodynia. |
| Topical agents that cause irritant or allergic reactions |
| |
| Medications that may result in painful clitoral tumescence[3-9] |
| |
| Antihypertensives | Sexual dysfunction appears to occur more frequently in hypertensive women. It is unclear whether this is associated with the hypertension itself or with antihypertensive medications. |
