“My labia feel like a cactus…”

“My underwear feels like sandpaper…”

“When I try to have sex, it feels like my tissue is tearing…”

These are all soundbites from patients I’ve treated who have been diagnosed with Vulvodynia.

Vulvodynia is one of many diagnoses I treat as a pelvic floor Physical Therapist, but it isn’t so much of a diagnosis as it is a description. That’s because Vulvodynia is chronic pain lasting 3 or more months on or around the vulva (the external genitalia) without a known or identifiable cause.  Basically vulvodynia means ‘you have pain in your vulva and we don’t know why.’

Since Vulvodynia is a diagnosis of exclusion (meaning there isn’t an obvious cause for symptoms such as an infection, a cyst or lump, menopause related tissue changes, or an irritated nerve), your care team must play detective to figure out the best course of treatment.

Background and Symptoms

Vulvodynia is an understudied condition estimated to effect around 14 million women in their lifetimes.  Symptoms typically begin between 18-25 years old and are often described as vulvar pain, burning, swelling, itching, or stinging.  I’ve had patients describe their pain as if they’re sitting on glass or that their underwear is made of sandpaper.

The most common form of Vulvodynia I treat, Localized Provoked Vestibulodynia (LPV),  involves pain on the lower portion of tissue around the vaginal opening (see image) that is provoked by physical touch such as attempts at penetrative intercourse, tampon use, or a speculum exam.  Generally, when this area is touched patients feel a cutting or tearing sensation at this already super sensitive part of the body.

This condition can be something that is always present from the first time someone attempts to use a tampon, or it can be something that can be developed after previously having no pain in this area.

Causes of Vulvodynia

The causes of Vulvodynia and, more specifically, Localized Provoked Vestibulodynia (LPV), can involve the following:

  1. Vulvar Tissue
  • This sensitive area can be affected by hormone levels (which change with breastfeeding, certain medications, and aging) and chronic inflammation and irritation (like from a non-healing scar or recurrent infections).
  1. The Pelvic Floor Muscles
  • Overactive or hypertonic pelvic floor muscles are common amongst those with LPV. When muscles are overactive, they can contribute to more vulvar pain.
  1. The Nervous System
  • When pain is chronic, pain receptors in that area increase their sensitivity over time causing an increase in activity along the nerve pathway connecting to the brain.

Physical Therapy Treatment

A Physical Therapist focuses on the pelvic floor muscle cause of vulvar pain.  A simple evaluation by your Physical Therapist will be able to determine if the pelvic floor muscles are contributing to your pain and if PT could be a helpful part of your rehab. The PT will work on reducing the pelvic floor muscle tension, teach you breathing and muscle lengthening techniques for your muscles, and also work on any other dysfunctions they find in the lower back, pelvis, or hip area. Your PT will also be able to help you with any bowel, bladder, or sexual dysfunction.

While undergoing treatment, it is important that you use the recommended medications as prescribed by your care team such as topical estrogen cream, lidocaine, or capsaicin.

Using lidocaine paired with your PT treatment can be a great way to reduce discomfort at PT sessions while also working to reduce your nervous system activity while receiving treatment to your pelvis. This can help your body and brain learn that physical touch to this area of your body does not always cause pain and can help the gradual return to sexual activities and pain free pelvic exams.

There is Hope!

A large majority of people with vulvodynia never seek treatment or bring it up to their physicians (some studies show up to about 50% never seek help!).  This is so unfortunate because people who do seek treatment ultimately report a reduction in symptoms as long as they find the appropriate providers to make up their care team.

If you are in the Portland, Oregon area, give us a call at 503-295-2585 to schedule an appointment to help you with your symptoms and begin your path to reducing your pain.

If you live outside Portland, we offer Telehealth visits which are a great way to get the benefits of seeing a PT from the comfort of your own home! You can also read our blog about “How to Find a Pelvic Health PT” to get advice on how to find a skilled provider in your area.

Helpful Resources for Those Seeking More Information

Dr Jill Krapf’s Instagram – Helpful bite size information on vulvovaginal disorders

National Vulvodynia Association Website

ACOG’s FAQs on Vulvodynia