Vulvodynia

Vulvodynia is pain in the vulvar region with no identifiable cause. An estimated 16% of women experience vulvodynia at some point in their lives.1 Many women think they need to “deal with it” on their own, and don’t seek out help. Know that you don’t need to accept vulvar pain – there is help available. The first step is to get informed.

What is Vulvodynia?

To understand vulvodynia, let’s first get to know the vulva. The vulva is the external female genitalia. It includes the mons pubis (pubic mound), the labia majora and minora, the clitoris and the clitoral hood, as well as the vaginal vestibule (the entrance of the vaginal opening). The vagina vestibule is not the same as the vagina, which is the muscular internal canal that connects the external opening to the uterus.

Vulvodynia is the medical term for pain in the vulvar region. Often times, there is no obvious identifiable cause for the pain, such as an infection, trauma or surgery. We all have pain from time to time, but when it lasts for at least three months, it may be a sign that it is vulvodynia. Your doctor will conduct an examination to diagnose vulvodynia. It can be challenging to diagnose vulvodynia because the pain may be generalized or localized. It may also be either provoked or unprovoked. Typically, it is a diagnosis of exclusion, meaning all other causes of vulvar pain have been ruled out.

Vulvar pain can feel different from one woman to the next. Often, women describe their symptoms as burning, stinging, itching or feeling “raw” in the vulvar area. Medically, vulvodynia pain is classified by:1

• Where: localized (affecting only the clitoris or vaginal opening), generalized (affecting the entire vulva) or a mix of the two

• How: provoked (requiring some form of contact), spontaneous (pain without a provoking factor) or a mix of the two

• Frequency: intermittent (now and then), constant or having a delayed onset after some form of contact

Although there is no identifiable cause of vulvodynia, research shows that there are some risk factors, including:1

• Other genitourinary conditions (e.g., urgency to urinate; painful urination)

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

• Hormonal factors

• Inflammation

• Overactive pelvic floor muscles (more on that below)

• A sensitized nervous system

• Anxiety and/or stress

• Changes in the structure of the vulva

Most women are diagnosed with vulvodynia between the ages 20 to 60 – but it can occur at any age.2

What Is The Role of The Pelvic Floor in Vulvodynia?

The pelvic floor is a group of dome-shaped muscles, ligaments, and tissue that are located at the bottom of the pelvic bones. A strong pelvic floor is vital for our health, and is needed for many daily functions that we may not even realize. This includes:

• 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

Women with vulvodynia 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 pain1,3

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 pain, soreness, and irritation.   

If you are experiencing vulvar pain, be sure to talk to your doctor so that a proper diagnosis can be made. 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. Pelvic floor physiotherapists are specially trained to help patients optimize the strength and coordination of their pelvic floor muscles. To treat vulvodynia, a Pelvic Health Physiotherapist will tailor a treatment plan to get to the root of your pain, and develop strategies to help minimize the pain. This treatment plan can include:

• Exercises to promote soft tissue and tension release in the pelvic floor

• Techniques to improve body awareness and posture

• Education to help you become aware of your body, and how to better control your pelvic floor muscles to help address pain and other symptoms

• Management of stress, anxiety and other psychosocial concerns that may be contributing to your pain

Pelvic physiotherapists can play a role in 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. Exposing our bodies to these stimuli – little by little – can change the way our nervous system responds to these stimuli. Through gradual exposure (e.g., starting with a light touch, and then working up over time), pelvic health physiotherapists can help improve your body’s awareness and pain response.

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 Vulvodynia?

At Proactive Pelvic Health Centre, we are passionate about destigmatizing women’s health and pelvic health issues. Often, women or vagina owners 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.