What is Vulvodynia?

Vulvodynia refers to pain of the vulva in the absence of infection or other medical causes, lasting more than 3 months. (Bornstein et al. 2016) The vulva refers to the external female genitalia and includes the mons pubis, clitoris, labia majora and labia minora, and associated glands in the region.

Up to 28% of women experience Vulvodynia (Bachmann et al. 2006) and almost half of these women will report an adverse impact on their sexual and psychological wellbeing.

Vulvodynia is a symptom, not a diagnosis. It’s like saying I have elbow pain. When the pain is felt more specifically at the vestibule it is termed Vestibulodynia and if it is felt at the clitoris it is termed Clitorodynia.

Wherever the pain may be felt, it may be provoked (tampon or speculum insertion, vaginal penetration, contact of sweat, lubricant or underwear), unprovoked (spontaneous) or mixed (both provoked and spontaneous).

Symptoms are further classified as:

• Primary: symptoms have always been there i.e. from the time you became sexually active or started wearing tampons
• Secondary: symptoms that arise after a period of no pain, commonly after vaginal delivery, menopause, stress or trauma.

Side note: vulvar pain- is pain of the vulva due to an identifiable cause such as

• Infection- Thrush or Herpes
• Inflammatory- Lichen sclerosus or Lichen planus
• Trauma- cuts, obstetric anal sphincter injuries
• Hormonal- menopausal or lactational
• Iatrogenic- chemo or radiation

WHY DOES VULVODYNIA HAPPEN?

The short answer: your body has decided that your vulva is in danger and needs protection. So not only in situations when there may be an infection, your body seems to think that it needs to protect the area even when you wear underwear, sweat, use a new lubricant or have sex…

1. Your immune system fires up and triggers an immune response- causing inflammation and swelling. Sometimes there may be redness
2. Nerves in the area become vigilant to make sure they are thoroughly able to assess and process the danger
3. Because of crosstalk between tissues, muscles and fascia tighten, or stop working effectively because you’re sore, to protect the area and prevent further damage. This condition is called vaginismus. However, this doesn’t always happen.

Vigilance leads to lots of information being sent to the brain to process, so even when you wear underwear, sweat, use a new lubricant or have sex it triggers this response.

Frankly speaking, this IS the defense mechanism that you want, when there is a threat!

Find out how you can perform a monthly vulva self-exam for greater awareness.

WHAT DO MY EMOTIONS HAVE TO DO WITH PAIN?

The emotional centre of the brain (limbic center) gets activated as the brain struggles to cope with all the information and manages the threat response. So, if you are having a bad day…you feel sad, anxious or unhappy or stressed it’s likely to intensify the pain as the emotions exacerbate the inflammatory response. After all emotions are chemical responses.

All of these events happen automatically as a protective response to a perceived threat. In fact, there doesn’t even have to be a real threat. The experience however is all real – real inflammation, real sensitivity, real pain.

WHAT ARE OTHER SYMPTOMS THAT MAY CORRELATE WITH VULVODYNIA?

There is now a growing area of research that suggests that in women who present with Vulvodynia, there may be other bodily disturbances that correlate with their symptoms including:

1. Restless leg syndrome

2. Chronic fatigue syndrome

3. Fibromyalgia

4. Temporomandibular joint disorder (TMJ)

5. Irritable bowel syndrome

6. Multiple chemical sensitivities

7. Neck injury (including whiplash)

8. Anxiety or panic attacks

9. Depression

But fear not. There is hope…

HOW CAN PHYSIOTHERAPY HELP?

Vulvodynia is likely not due to one problem and as such requires an individualised and multimodal approach. (Morin, Carroll & Bergeron 2017) Physiotherapy essentially involves calming the mind-body connection to ensure that the brain doesn’t think your vulva is in danger.

WHAT DOES PHYSIOTHERAPY MANAGEMENT LOOK LIKE?

• Work alongside your doctor to help identify the best course of treatment
• Make recommendations for appropriate vaginal moisturisers and lubrication
• Design a personalised pelvic floor muscle program with appropriate stretches
• Introduce graded touch and tissue desensitisation techniques
• May involve the use of electrical stimulation devices to calm nerve signals
• Recommend a dilator program, using vaginal trainers
• Discuss approaches to a fulfilling intimate relationship
• Refer to a sexual counsellor or psychologist to address changes in body image, sexuality, fear, anxiety, and coping
• Support your emotional and physical health
• Help you embrace life!

IN SUMMARY:

1. There are changes to the parts of the brain that are responsible for the movement (motor) and feelings (sensory) that relate to the vulva
2. There are changes in how sensitive the nerves that supply the vulva and surrounding structures
3. There are changes in how much attention the brain pays to the vulva
4. The brain believes the vulva to be in danger
5. Due to close proximity and cross-talk between the vulva and the pelvic floor structures (muscles and fascia)- there can be tension
6. Physiotherapy can help in making sense and alleviate your symptoms to help you embrace life.

If you are suffering from vulvodynia, please do call/WhatsApp on 9780 7274 or get in touch over email to discuss what your journey can look like with the right care.

You can also visit our website to learn about other women’s conditions we treat through physiotherapy and how we can help you.

References:

Bornstein, J, Goldstein, AT, Stockdale, CK, Bergeron, S, Pukall, C, Zolnoun, D & Coady, D 2016, ‘2015 ISSVD, ISSWSH and IPPS Consensus Terminology and Classification of Persistent Vulvar Pain and Vulvodynia’, Obstet Gynecol, vol. 127, no. 4, pp. 745-51.

Morin, M, Carroll, MS & Bergeron, S 2017, ‘Systematic Review of the Effectiveness of Physical Therapy Modalities in Women With Provoked Vestibulodynia’, Sex Med Rev, vol. 5, no. 3, pp. 295-322. Available from: PubMed. [26 April 2020].