Vulvodynia

The vulva is the part of the genitals on the outside of the female body. No two vulvas look the exact same but they have the same basic structures.

The Main Parts of the Vulva Include:

• Mons Pubis: Located above the vulva and is often covered with pubic hair after puberty.
• Clitoris: Located at the top of the vulva, where the inner lips meet. It is a spongy tissue that becomes swollen when aroused (turned on). Each person’s clitoris is a different size ranging from a small pea to as big as a thumb. The clitoris extends inside the body, back and down the sides of the vagina.
• Labia Majora: The folds of skin (outer lips) usually covered with pubic hair.
• Labia Manora: The folds of skin (inner lips) that are hairless. They begin at the clitoris and end under the opening of the vagina.
• Opening: Where menstrual blood leaves the body and babies are born.
• Vestibule: Surrounds the entrance of the vagina.
• Urethra: Tiny hole where the urine exits the body, located under the clitoris.

Contrary to popular belief, the vagina is actually what’s inside the body, connecting the vulva to the cervix and uterus.

Vulvodynia can be defined as pain and/or discomfort in the vulva, occurring in the absence of another health problem. Symptoms should be present for 3-6 months before a diagnosis of vulvodynia is considered.

Vulvodynia is a diagnosis of exclusion, which means other conditions such as infections, skin disorders or other medical conditions need to be ruled out.

Vulvar Symptoms May Include:

• Burning
• Stabbing
• Stinging
• Itching
• Allodynia (Light touch perceived as pain).
• Hyperalgesia (Small pain perceived as great).

Other Symptoms May Include:

• Functional limitation (sex/ tampon/ sitting/ clothes/gynecological exam)
• A decrease in one’s quality of life
• Anxiety
• Depression
• Stress
• Sleep disturbances
• Altered body image

Vulvodynia is a broad category of pelvic pain that can be broken down into smaller subset diagnoses such as:

• Generalized vulvodynia: Effects the entire vulva.
• Localized vulvodynia: Localized to the vulvar vestibule (surrounds the vaginal opening) and is often referred to as vestibuloynia (previously referred to as vulvar vestibulitis).

Provoked Vestibulodynia (PVD) Can Be Classified As:

• Primary PVD: Experiencing pain at first attempt of vaginal penetration or insertion.
• Secondary PVD: Have experienced pain-free sexual penetration or insertion prior to the development of vulvar pain.

Symptoms Can Be:

• Provoked (sexual, nonsexual or both).
• Mixed (provoked and spontaneous).

The Temporal Pattern Can Be:

• Intermittent
• Persistent
• Constant
• Immediate
• Delayed

Pelvic health physiotherapy is an integral part of a multidisciplinary team in the treatment of symptoms associated with vulvodynia. Treatments may include:

• Vulvar skin health education.
• Bowel and bladder education.
• Pain education.
• Diet modification.
• Therapeutic exercise.
• External myofascial techniques.
• Internal myofascial techniques.
• Use of dilators/accommodators.
• Treatment of the nervous system.

An excellent fact sheet on central sensitization and vulvodynia can be found here. There is real hope since the nervous system is plastic, and what has changed, can be changed back again.

You may consider speaking to your physician to see if you are a candidate to use hormonal compounds and creams to try to rebalance the hormonal drivers that might be present in the pain syndromes of vulvodynia.

Here’s a helpful resource for vulvodynia:

National Vulvodynia Association.
Understanding Pain: What to do in about 5 minutes: https://www.youtube.com/watch?v=RWMKucuejIs