Vulvar & Vaginal Pain

What is Vulvar and Vaginal Pain?

Chronic pain conditions associated with the vulva and vagina are common yet under-reported and under-treated. Research studies show that as many as 16% of women in the United States suffer from vulvodynia at some point in their lives. The highest incidence of symptom onset is between the ages of 18-25. Types of pains conditions associated with the vulva include:

Vulvodynia: A broad term used to describe any chronic pain, itching, or burning in the vulvar area that lasts for at least three months. The term encompasses a variety of conditions with similar symptoms.

Dyspareunia: Pain during intercourse due to any cause. This may occur at the opening during attempted penetration or with deep penetration, which is most often associated with other issues such as endometriosis, uterine fibroids, and bladder or bowel hypersensitivity.

Dysesthetic Vulvodynia: The word dysesthesia means “altered sensation”. Symptoms include chronic or intermittent burning, stinging, itching, rawness and irritation to the vulva. The discomfort varies and can occur without being touched in the area.

Vulvar Vestibulitis: Pain located only in the vulvar vestibule, which is the shiny mucous tissue surrounding the vaginal opening often felt in a U-shaped area at the base of the vaginal opening. Symptoms are generally described as a sharp stabbing or cutting sensation. Pain is always worse with provocation, such as with intercourse, tampon insertion, or wearing tight clothing. Some may experience post-intercourse burning pain, which can last from 1 to 24 hours.

Vaginismus: Involuntary muscle contraction of the outer third of the vagina that interferes with penile insertion and intercourse. It is often caused by a combination of physical and non-physical triggers that cause the body to anticipate pain. Reacting to the anticipation of pain, the body automatically tightens the vaginal muscles, bracing to protect itself from harm.

Factors Contributing to Vulvar and Vaginal Pain:

An injury to, or irritation of,the nerves that transmit pain from the vulva to the spinal cord. This can occur with a fall on the tailbone, chronic straining, childbirth and sustained repetitive cycling

An increase in the number and sensitivity of pain sensing nerve fibers in the vulva

Inflammation in the vulva that may be associated with chronic vaginal or bladder infections

Chronic pelvic floor muscle tightness and/or weakness

Allergies or sesnsitive skin

Hormonal changes

History of sexual abuse

How Can Donna Sarna Physiotherapy Help?

At Donna Sarna Physiotherapy & Rehabilitation, a pelvic floor assessment is a two-part process with a global approach taken both with assessment and with treatment. During the assessment process, a detailed history as well as an internal and external evaluation will occur incorporating not just the pelvic floor, but also assessment of posture, as well as range of motion and strength of the torso, back, hips, pelvis and lower extremities and examination of the associated musculature and fascia as well as the nerves and joints. The pelvic floor component will include an external evaluation of the skin and connective tissue in the perineal and vulvar areas as well as an internal examination of the vagina and possibly the anal canal if indicated. The pelvic floor muscles and sphincters are tested for muscle tone and tightness, strength, endurance, trigger points, and tissue integrity. The pelvic floor is also assessed in conjunction with the rest of the core to ensure that timing of activation and sequencing of the muscles is optimal. Position of the pelvic organs and integrity of their supporting ligaments and fasciae are also evaluated. You are always welcome to have a trusted individual present during assessment or treatment.

An individual treatment plan is developed based on the assessment findings and may include education regarding posture, breathing and relaxation techniques, dietary considerations, and perineal care. Manual techniques including myofascial release, mobilization, visceral manipulation and biofeedback will also be utilized as a component of the treatment plan. Insertion techniques (dilation therapy) may also be a component of treatment. An individualized home exercise program will also be provided to release and lengthen the muscles. Strengthening will be included when appropriate with a whole body approach to include the pelvic floor, but not specific to. Modalities such as acupuncture, heat and cold may be utilized as well as home biofeedback to aid with relaxation of the pelvic floor and associated muscles.