Vulvodynia and Vestibulodynia
Condition Overview
Vulvodynia is an umbrella term when a patient experiences chronic and unexplained pain in the external genitalia (vulva) that lasts for three months or more with no apparent cause. The vulva includes the clitoris, labia, vaginal opening and urethral opening. If you are just experiencing pain at the opening of the vagina this is called vestibulodynia.
What Does Vulvodynia Pain Feel Like?
Burning
Soreness
Rawness
Stinging
Dryness
Throbbing
Itching
These symptoms can worsen with prolonged sitting (such as bike riding, travel, desk work); during or after intercourse; wiping after urination; pelvic exams; and tight-fitting clothing (jeans/underwear).
The pain associated with vulvodynia can be provoked or unprovoked and can be constant or intermittent.
Causes
The causes of vulvodynia are not clear; however, researchers believe there may be a combination of factors that increase your likelihood of developing vulvodynia. These include:
pelvic floor muscle overactivity
recurrent yeast or other vaginal infections
Dyspareunia
irritation to the pudendal nerve (nerve that supplies motor and sensation to the pelvic floor) or an increase in pudendal nerve receptors
allergies/sensitive skin
hormonal changes
depression or other mood disorders
interstitial cystitis/painful bladder syndrome
fibromyalgia.
How Can Physical Therapy Help?
It will be important to have a multi-disciplinary approach to treating vulvodynia/vestibulodynia and physical therapists will play a major role in treating and managing your symptoms.
In pelvic health therapy we will discuss your symptoms and go over each of the systems of the pelvic floor (bladder, bowel, sexual health, and gynecological health) in order to diagnose your symptoms appropriately.
With your consent we will perform an external and internal pelvic floor muscle assessment. We will assess your abdominal wall, low back/hips, adductors, and superficial and deeper pelvic floor muscles. We will determine your muscle function, strength, endurance, and coordination.
If you cannot tolerate an internal vaginal assessment we always stop at your tolerance and never push you to handle more than you can. We move at a slow pace to ensure we are not generating a larger pain response which can slow progress down.
From our findings we will set-up a treatment plan depending on your pelvic floor characteristics! For vulvodynia and vestibulodynia, we will discuss proper hygiene techniques, behavioral modifications, and appropriate movement strategies.
We will perform manual treatment to desensitize the tissues and improve tissue mobility and extensibility. Manual treatment can include but is not limited to dry needling, myofascial release, cupping, and connective tissue mobilization. We also may include dilator or pelvic wand training in order to teach these muscles how to relax and lengthen.
We will work to improve your pelvic floor muscle coordination ensuring you can appropriately contract (kegel) the pelvic floor and relax/lengthen the pelvic floor when necessary.
With each session we will reassess and progress appropriately to ensure good outcomes when out of the clinic!