Vulvodynia & Pelvic Health Physical Therapy

Do you have pain or discomfort wearing tight fitted clothing, tampon insertion, or prolonged periods of sitting down? You may be experiencing vulvodynia. In this article, we review what vulvodynia is, causes, and treatment - including physical therapy.

What is Vulvodynia?

As pelvic health physical therapists, we treat cases of vulvodynia frequently.

The Vulva is the external part of a woman’s genitalia, including the entrance to the vagina (vestibule), clitoral region and also the plump, fatty tissue of our labia and mons, overlying the pubic bone.  

Vulvodynia is pain at the vulva lasting greater than 3 months, described as burning, stinging and sensitive to touch. Sometimes, this pain is only present at the vestibule, clitoris or labia. Other times, pain is widespread through the vulvar tissues. 

Causes of Vulvodynia

Vulvodynia may be present only when provoked by touch or pressure, or at all times. Vulvodynia may be exacerbated with sexual intercourse, tampon insertion, gynecologic exam, prolonged sitting and/or wearing tight fitted clothing. 

Vulvodynia can be complex in that there are more than one potential causes of the condition. Hormonal, inflammatory and/or congenital factors can be implicated. Sometimes, history of infection of the region including yeast and urinary tract infections may contribute. To add another layer, vulvodynia may overlap with other pelvic pain syndromes. 

Treatment

Like many pelvic pain conditions, research in the area of vulvodynia treatment is lacking. Pelvic Physical Therapy (PT) can help treat vulvodynia effectively, incorporating manual techniques and exercise.

Medically, vulvodynia may be treated with local anesthetics, oral or topical medications. Some research implies influence of gut bacteria and dietary components, suggesting elimination diets may be helpful in some patients. This is not surprising, given the proposed connection between gut health and most other pelvic pain conditions. Again, more research is needed. 

Depending on the cause, the condition may be best treated as a dermatological issue, hormonal or a musculoskeletal issue. In some cases, a biopsy may be taken to provide more info to your medical provider. 

The right vulvodynia treatment depends on specific medical history, impairments and symptoms on exam. 

Physical Therapy and Vulvodynia

For proper treatment of any vulvodynia case, a physical therapy evaluation is a crucial piece.. 

There are nerves that communicate between organs and the brain, muscles and the brain, organs and muscle, skin and muscles, etc. Because there is so much cross talk between nerves in the pelvis, pain in one place can impact the function of nearby tissues, whether or not they are the original source. 

Regardless of the cause, there is a good chance the pelvic floor muscles and connective tissue are involved or have become involved in vulvodynia symptoms. There are behavioral strategies that your pelvic physical therapist can help you work through to promote improved function in all of these tissues. By examining your pelvic floor, your physical therapist can determine what exacerbates and relieves your specific pain in order to design an individualized treatment plan.

What Does Physical Therapy for Vulvodynia Involve? 

Physical therapy  for vulvodynia often involves myofascial release, desensitization, breathing and mobility techniques. An effective PT program will include a home exercise plan, which often involves the use of vaginal dilators to help improve your body’s tolerance to touch and pressure. 

Although pelvic floor strength may be a long term goal for someone with vulvodynia, it should rarely, if ever, be the first place to start. This is a common misconception that ‘all pelvic floor conditions call for Kegels and strength’. Sadly, Kegels and strengthening of the pelvic floor muscles at the onset of treatment can make symptoms worse. 

Addressing Vulvodynia With a Physical Therapist

Vulvodynia often requires management from more than one healthcare professional in order to create a truly comprehensive and effective treatment strategy. To address pain and pelvic floor muscle dysfunction, consult with a local Las Vegas pelvic floor physical therapist as part of your treatment team.