Vulvodynia 101

What is the vulva? 

The vulva is the external female genitalia that includes the: 

- Clitoris 

- Prepuce (clitoral hood) aka the skin surrounding the clitoris

- Labia majora and minora, which are the larger and smaller lips surrounding the vestibule 

- Vestibule

- Mons pubis, the area typically covered in pubic hair located directed in front of the pubic bone 

What is Vulvodynia? 

Vulvodynia is a painful condition of the vulva characterized by chronic burning, stinging, or raw discomfort that may be constant or intermittent and lasting >3 months.  Symptoms may be present throughout the entire vulva or only in a small area. Vulvodynia is thought to affect up to 16% of women but may be underdiagnosed due to the condition being poorly understood.  Vulvodynia is given as a diagnosis when there is no other visible cause for the pain felt in the vulva and all other diagnoses have been ruled out by medical examination.  Some causes of vulvar tissue irritation can be hormonal changes, dermatological skin conditions, muscle dysfunction (tightness), or infections such as bacterial vaginosis (BV) or yeast.  With vulvodynia, the sensation of pain remains even when the skin infection or irritation is resolved.  Pain can occur spontaneously or only when the vulva is touched.  Ongoing pain and burning can impact all aspects of life by causing distress, anxiety, and affecting sexual relationships.  

Types of vulvodynia  

• Localized vulvodynia: the pain is in one specific area of the vulva, usually the opening of the vagina (vestibule)

• Generalized vulvodynia: the pain can be in different areas of the vulva or diffuse

Causes of Vulvodynia 

There is no specific cause for developing vulvodynia but researchers believe it may be related to:

• Nerve injury or irritation

• Chronic inflammation

• Muscle spasm or pelvic floor dysfunction 

• Hormonal changes 

• History of sexual abuse or PTSD 

• Allergies or irritation to chemicals 

• Trauma to the area 

• Frequent antibiotic use 

• IBS

• Interstitial cystitis (painful bladder syndrome) 

Treatment with Pelvic Floor PT

Treating vulvodynia most often requires a multi-disciplinary approach.  Typically when a person has vulvar pain, pelvic floor dysfunction is also present.  Pelvic floor physical therapy will focus on decreasing the heightened state of tension and tone in your pelvic floor muscles.  This can be achieved through a number of different treatment techniques such as internal and external soft tissue/myofascial release, biofeedback, manual techniques, breathing, dilator or pelvic wand use, and lengthening of muscles through therapeutic exercise.  Like with most pelvic pain conditions, vulvodynia should not be treated with kegels, or pelvic floor muscle contractions.  Vulvar pain can also be related to other parts of the body, such as the back or hips, which will be addressed through a musculoskeletal assessment.  A pelvic floor PT will also be able to recommend behavioral or lifestyle modifications that can promote healing and pain reduction.

References:

Jahshan-Doukhy O, Bornstein J. Long-Term Efficacy of Physical Therapy for Localized Provoked Vulvodynia. Int J Womens Health. 2021 Feb 10;13:161-168. doi: 10.2147/IJWH.S297389. PMID: 33603495; PMCID: PMC7882794.

Harlow BL, Stewart EG. A population-based assessment of chronic unexplained vulvar pain: have we underestimated the prevalence of vulvodynia? J Am Med Womens Assoc (1972). 2003 Spring;58(2):82-8. PMID: 12744420.