Persistent Vulvar Pain? You May Have Vulvodynia
Vulvodynia Explanation and Treatments:
Persistent vulvar pain can be distressing and confusing, especially when the cause is unclear. If you experience pain in the vulva that lasts for three months or more, you might have a condition called vulvodynia. This condition can affect women of all ages, with about 7% of women in the United States experiencing symptoms. (1) The pain can vary in sensation, severity, and frequency, making everyday activities like sitting or having sexual intercourse uncomfortable. Let’s explore what vulvodynia is, its symptoms, causes, risk factors, diagnosis, and available treatments.
What is Vulvodynia?
Vulvodynia is a chronic pain condition characterized by pain in the vulva area, which is the external part of the female genitalia. For pain to be considered vulvodynia, it must persist for at least three months without other known identifiable cause. The exact cause of vulvodynia is not well understood, and it can occur at any age, although it is most common among young women between the ages of 18 and 25.
Subtypes of Vulvodynia
Vulvodynia can be categorized into more specific subcategories depending on the nature of symptoms.
Generalized Vulvodynia: Pain is diffuse in the vulvar area and may extend past the vulva into the perineum or inner thighs
Provoked Vulvodynia: This is the majority of cases, in which pain is located primarily in the vestibule and or vaginal opening that is triggered by touch
Primary Vulvodynia: People have experienced pain since first attempt at vaginal penetration
Secondary Vulvodynia Those who had prior experiences of vaginal penetration without pain
Vulvodynia Visual Description
This image highlights the anatomical areas commonly affected by different types of vulvodynia. The inner labia, vestibule, hymen, vaginal canal, and posterior fourchette are shown, where pain may occur. In Provoked Vulvodynia, pain is typically felt in the vestibule or vaginal opening upon touch. Generalized Vulvodynia may involve widespread pain across the vulva, extending to the perineum or inner thighs. Primary Vulvodynia is characterized by pain from the first attempt at penetration, while Secondary Vulvodynia occurs after a period of pain-free penetration.
Symptoms of Vulvodynia
Symptoms of vulvodynia vary widely among individuals. The most common symptom is a burning or stinging sensation in the vulva. The pain can be constant or occur only during specific activities, such as prolonged sitting or sexual intercourse. Other common symptoms include:
Irritation or rawness sensation in the vulva
Pain during intercourse (dyspareunia)
Pain when sitting for long periods
Itching or throbbing in the vulva area
Discomfort when wearing tight clothing
These symptoms can significantly affect a person’s quality of life, making simple activities painful or uncomfortable.
What Causes Vulvodynia?
The exact cause of vulvodynia is often unknown, but several factors have been hypothesized to contribute to its development:
Pelvic Floor Muscle Dysfunction: Tight or weak pelvic floor muscles can contribute to pain.
Pelvic Nerve Irritation or Injury: Nerve irritation or injury in the pelvic region can lead to vulvar pain.
Hormonal Imbalance: Changes in hormone levels, particularly estrogen, can affect vulvar health.
Allergic Reactions: Allergies to products like soaps, lotions, or fabrics can cause vulvar irritation and pain.
Recurring Vaginal Infections: Frequent yeast infections or bacterial vaginosis can cause an elevated inflammatory response that irritate the vulva and cause pain.
Risk Factors for Vulvodynia
Certain factors may increase the risk of developing vulvodynia, including:
Pelvic Floor Muscle Dysfunction: Women with pelvic floor issues may be more prone to vulvar pain.
Having Certain Allergies: Allergic reactions to personal care products or medications can increase the risk.
Autoimmune Disorders: Conditions like Lichen Sclerosis, an autoimmune disease, can cause chronic vulvar pain.
Recurrent Vaginal Infections: Frequent infections can lead to inflammation and pain in the vulva.
Exposure to Birth Control: Hormonal birth control methods may affect vulvar sensitivity.
Stress, Anxiety, Depression, or Emotional Trauma: Mental health issues can amplify physical pain, including vulvar pain.
Pelvic Pain Disorders: Conditions like painful bladder syndrome (interstitial cystitis) or endometriosis can increase the risk of vulvodynia.
Diagnosing Vulvodynia
Diagnosing vulvodynia requires a comprehensive approach, including a detailed medical history, symptom assessment, and physical examination. The journey to diagnosing vulvodynia can be difficult for both patients and healthcare providers because it is a diagnosis of exclusion without known specific cause.
Here’s what you can expect for vulvodynia diagnosis from a pelvic floor PT evaluation at Chicago Pelvic Health and Wellness:
Medical History and Symptom Discussion: Your provider will ask about your symptoms, medical history, and lifestyle to understand better what might be causing your pain.
Posture and/or Movement Examination: An external examination of your posture, hips, abdomen, and sacrum will be performed to check for any signs of discomfort, pain, or dysfunction.
Cotton Swab Test: This tests the neuropathic component, which involves using a cotton swab to gently press various areas in the vulvar to identify areas sensitivity or pain.
Internal Examination: With your consent, an internal exam will evaluate the pelvic floor muscles and nerves. This does not involve a speculum and focuses on assessing muscle tension and coordination.
Start of Treatment: In many cases, treatment can begin the same day to alleviate pain and improve function.
Further Tests: Sometimes, other tests such as blood tests, biopsies, or imaging tests like MRIs may be needed to rule out other conditions.
Treatment Options for Vulvodynia
Vulvodynia can be challenging to treat, but there are several effective, non-invasive options available. Among these, Pelvic Floor Physical Therapy (Pelvic PT) stands out as one of the first line non-invasive and medication-free option. (1) Here’s why:
Pelvic Floor Physical Therapy: The First line Non-Invasive Option
Pelvic Floor Physical Therapy (Pelvic PT) is highly recommended in treating vulvodynia because it targets a large contributing factor to vulvar pain: the pelvic floor muscles. When these muscles are either too tight or too weak, they can cause or exacerbate vulvar pain. Pelvic PT involves specific exercises and techniques that focus on relaxing, strengthening, and properly coordinating the pelvic floor muscles. Here’s how it works:
Muscle Relaxation Techniques: Pelvic PT helps to relieve tension in the pelvic floor muscles. Techniques like manual therapy, trigger point release, and pelvic floor down training techniques can help reduce muscle spasms and discomfort, leading to a significant reduction in pain.
Strengthening and Coordination Exercises: Strengthening the pelvic floor muscles can improve their ability to support the pelvic organs and possibly reduce nerve irritation in the pelvic region thus reducing pain. Pelvic floor exercises that focus on strength, stability, or coordination of the pelvic floor or surrounding muscles can help better support the pelvis eliminating muscular imbalances that could be causing vulvar pain.
Breathing and Relaxation Exercises: These exercises help reduce overall muscle tension and promote relaxation in the pelvic area through stimulation of our parasympathetic nervous system or “relaxing nervous system”. This can reduce pain sensitivity.
Education and Lifestyle Modifications: A pelvic floor physical therapist can provide guidance on activities and lifestyle modifications to avoid triggers and manage symptoms while addressing muscle tension or nerve irritation. This includes advice on sitting positions, clothing choices, use of tools like a TENS unit, and hygiene practices that minimize irritation and pain.
Pelvic PT is a holistic approach that not only focuses on the physical aspects of vulvodynia but also addresses the emotional and psychological impact of chronic pain. It provides a supportive environment for patients to discuss their symptoms and concerns openly, contributing to a comprehensive pain management plan.
Other Treatment Options
Supplementation of other options can be very helpful during pelvic floor PT and support healing more effectively. In addition to Pelvic PT, other treatment options for vulvodynia may include:
Medications: Topical anesthetics, nerve pain medications, suppositories, or hormonal treatments may be prescribed to manage pain.
Injections: These can help manage pain by blocking pain signals from affected nerves, or help to relax muscles in spasm.
Counseling or Cognitive Behavioral Therapy (CBT): Addressing emotional and psychological aspects of chronic pain can be beneficial.
Surgery: In rare cases, surgery may be recommended to remove affected tissue.
It is important that treatment and care for vulvodynia is multidisciplinary. The right treatment combination for each person is unique and can take time to determine what works best.
Frequently Asked Questions
1. Are there preventative steps to avoid vulvodynia?
Maintaining good vulvar hygiene, avoiding irritants, and managing stress can help reduce the risk.
2. What are the risks if vulvodynia is left untreated?
Untreated vulvodynia can lead to chronic pain, emotional distress, and reduced quality of life.
3. Are there other related conditions to vulvodynia?
Yes, conditions like interstitial cystitis, endometriosis, and lichen sclerosis can be related to vulvodynia.
4. When should I seek treatment for vulvodynia?
Seek treatment if you experience persistent vulvar pain that affects your daily activities or quality of life.
5. What can I expect at my appointment?
Expect a thorough assessment of your symptoms, medical history, and a physical examination to determine the best treatment plan.
Conclusion
Vulvodynia can be a challenging condition, but effective treatments are available to manage pain and improve your quality of life. Pelvic Floor Physical Therapy (Pelvic PT) offers a non-invasive, medication-free approach that addresses the large contributing factors to vulvar pain and provides and effective route to relief. If you suspect you have vulvodynia or experience persistent vulvar pain, consult a specialist at Chicago Pelvic Health and Wellness to get the care you need. Don’t let pain control your life—take the first step toward relief today.
Dr. Jana Richardson, PT, DPT, WCS, PRPC, CIDN
Dual Board Certified Pelvic Floor Therapist and Owner of Chicago Pelvic Health
Dr. Jana Richardson is a highly accomplished pelvic floor therapist with dual board certifications and extensive experience in treating complex pelvic floor dysfunctions. As the owner of Chicago Pelvic Health, Dr. Richardson is dedicated to providing personalized and effective care for her patients. With a Doctorate in Physical Therapy, and specialized certifications in Women’s Health and Pelvic Rehabilitation, Dr. Richardson is a leading expert in her field. She is also certified in Integrative Dry Needling, further enhancing her ability to offer comprehensive treatment plans. Dr. Richardson’s commitment to patient-centered care and her passion for helping individuals achieve optimal pelvic health make her an invaluable asset to the community.
