Vestibulodynia (Vulvar Vestibulitis)

Vestibulodynia is chronic pain and discomfort in the vestibule, which is the area around the opening of the vagina inside the inner lips of the vulva. Pain is usually provoked by pressure or touch, such as intercourse or tampon insertion. The pain can be hard to identify – but once it is, a treatment plan can be initiated to help you manage your symptoms, and improve your quality of life.

What is Vestibulodynia?

Vestibulodynia is chronic pain, sensitivity and discomfort (lasting 3 months or more) with no known medical cause that occurs in the vestibule, which is the area around the opening of the vagina inside the inner labia or lips of the vulva. It is a more specific form of vulvodynia. In most cases of vestibulodynia, the pain is provoked. This means that the pain is localized and triggered by pressure or touch. The most common triggers are:

• A pelvic exam (i.e., a pap smear)

• Penetrative sex (painful intercourse is known as dyspareunia)

• Tampon insertion

• Sitting for a long time or wearing tight-fitting clothes (if symptoms are severe)

In addition to pain, women with vestibulodynia often experience redness, irritation and sensitivity in the vestibular area. These symptoms can negatively impact a woman’s quality of life, interfering with intimacy and everyday activities. Vestibulodynia was previously referred to as Vulvar Vestibulitis Syndrome (VVS). Some healthcare professionals may still use this term.

The precise location of the pain is difficult for many women to identify. It is also highly variable – some women may tolerate penetrative sex, while others feel pain even with light touch. If you’re experiencing vulvar pain of any kind, the best course of action is to see your doctor for an assessment and diagnosis.

Who is At Risk of Vestibulodynia?

We don’t know exactly what causes vestibulodynia. However, research suggests that the following factors may be linked to it, or make existing symptoms worse:

• Chronic yeast infections

• Trauma (e.g., difficult childbirth)

• Sensitivity to irritants in detergents or soaps

• Genetics (i.e., it runs in the family)

• Hormonal changes

• Stress or anxiety

• Damage or irritation of the nerves of the vulva

What Is The Role of The Pelvic Floor in Vestibulodynia?

 The pelvic floor is a group of dome-shaped muscles, ligaments, and tissue that are located at the bottom of the pelvic bones. Our pelvic floor is vital to many aspects of our health and function, including:

• Providing support to the pelvic organs (e.g., bladder, uterus, bowels)

• Offering stability to the low back and hip joints

• Maintaining bladder and bowel continence

• Optimizing sexual sensation and arousal

Similar to vulvodynia, women with vestibulodynia often experience changes in their pelvic floor, including:

• Shortening or tightening of the pelvic floor muscles

• Weakness of the pelvic floor, leading to poor control

• Reflexive muscles spasms in response to pain1,2

A weakened and tight pelvic floor can compromise the natural circulation of blood flow and oxygen with the tissues of the pelvis, which surround the vulvar region. This can lead to a build-up of lactic acid, resulting in vulvar and/or vestibular pain, soreness, and irritation.  

If you have been experiencing pain in the vulvar region – even if you’re not sure exactly where – talk to your healthcare professional. Effective treatments are available, including pelvic health physiotherapy.

How Can Pelvic Health Physiotherapy Help Me?

Pelvic health physiotherapy can play a significant role in helping women suffering from chronic vulvar pain, including vestibulodynia. Pelvic floor physiotherapists are specially trained in helping patients optimize the strength and coordination of their pelvic floor muscles. Unlike vulvodynia, the pain associated with vestibulodynia is localized to one area (the vestibule), so treatment can be targeted to this area. Our Pelvic Health Physiotherapists will tailor a treatment plan to get to the root of your pain, and develop strategies to help minimize your symptoms. This treatment plan can include:

• Vaginal dilators. Vaginal dilators work by progressively stretching and desensitizing the vaginal tissues. Over time, increasingly wider dilators are used (based on your progress and comfort level). Vaginal dilators can be very effective in helping women overcome pain during intercourse.

• Manual therapy. This involves various hands-on techniques, such as stretching, facilitation, soft tissue massage, mobilization and trigger point release targeted to the affected muscles and tissues.

• Education. A deeper understanding of the anatomy of the pelvic floor, how lifestyle factors, diet, urinary and bowel hygiene can affect it, and techniques to effectively use your pelvic floor muscles are vital to your recovery.

• Treating a sensitized nervous system. Sometimes, our nervous systems become overly sensitive to pain stimuli, such as touch or vaginal penetration. This is especially true if we’ve learned to associate a particular stimulus with being painful. Gradually exposing our bodies to these stimuli can change the way our nervous system responds to that stimuli and improve our pain response.

• Biofeedback. An electrical or mechanical device is used to help you visualize pelvic muscle contraction and relaxation. This can help you learn how to better use your pelvic floor muscles.

Often, a number of sessions are required. Your Pelvic Health Physiotherapist will customize a plan to your unique needs and goals.

How Do We Approach Treatment For Vestibulodynia?

At Proactive Pelvic Health Centre, we are passionate about destigmatizing women’s health and pelvic health issues. Often, women feel as though they are overreacting or that their pain isn’t real. Our first step in treatment is to acknowledge that how you feel is real. We work to understand your pain experience, and then build a personalized treatment plan that works for you.

Our approach is compassionate, holistic and evidence-based using a combination of education and clinical care to put you on a positive course to achieving your pelvic health and wellness goals. We’re with you every step of the way, whether it be to answer your questions or simply give you a pep talk to help keep you motivated and moving forward.