The Role of Physical Therapy in Managing Vulvodynia

“Vulvar pain affects up to 20% of women at some point in their lives, & most women with vulvar pain have associated pelvic floor impairments. Pelvic floor dysfunction is associated with significant functional limitations in women by causing painful intercourse and urinary, bowel, and sexual dysfunction. It is now known that vulvar pain syndromes are varied in origin; therefore, successful treatment plans [such as those provided by Vulva Pain Doctors at the London Vulva Clinic], are multimodal and include physical therapy” [1]

Vulvodynia sufferers who report sex-related pain are often diagnosed with pelvic floor muscle dysfunction. Indeed, when unusually high muscle spasm or tone and sub-optimal contraction is present, then various proven beneficial exercises should be given to the patient. Research indicates that a percentage of vulvodynia sufferers experience pelvic floor muscle spasm or weakness. To that end, after you have had an online or in-person consultation with a Vulva Pain Doctor, and they have reviewed your medical history, asked you pertinent questions, and arranged any necessary examination, tests and scans, they will then be in a position to provide you with an accurate vulvodynia diagnosis.

As vulvodynia is a highly complex condition, after your diagnosis has been ascertained, your Vulva Consultant will be able to explain the different facets of this disorder which are affecting you personally. They will then draw up a comprehensive Holistic Personalised Treatment Plan which will incorporate both conventional medication and the latest cutting-edge therapies and injectables. And if you have pelvic floor dysfunction, then pelvic floor physical therapy will be part of  your Personalised Treatment Plan.

Physiotherapy For Pelvic Floor Muscles

When you have your first vulvodynia physiotherapy appointment at the London Pain Clinic, the physiotherapist will evaluate the nerves, muscles and joints in the lower part of your body. To that end, the results of this testing will determine whether or not your pelvic floor muscles are adding to your vulva pain. If you do need vulva physical therapy, then you can expect the following:

• Active pelvic floor retraining
• Guidance on stretching and relaxing the pelvic floor muscles in order to help ameliorate pain from vulvodynia. (Countless vulvodynia patients suffer from tension in these muscles. The latter are extremely important as they support the uterus, bowel and bladder)
• Massage
• Soft tissue work
• Joint mobilisation
• Education on how sub-optimal pelvic floor functioning is impacting their condition, and how a workable treatment plan can be beneficial [2]

Associated Modalities For Pelvic Floor Dysfunction

In addition to the aforementioned, rehabilitating the muscles in the pelvic floor could also involve utilising a biofeedback machine, and/or inserting a vaginal sensor. A biofeedback machine serves to deliver visual feedback on the pelvic floor muscles’ strength whilst simultaneously executing exercises in order to optimise their function [2].

Booking an Appointment With a Vulva Doctor

If you are experiencing any type of vulva pain, then the best course of action is to book an in-person or online appointment with a Vulva Specialist as soon as possible. This is very important, as you do not want your condition to become worse. Unfortunately, as things currently stand in the UK, very few GPs have undergone the necessary additional years of training and clinical experience in pain conditions (including vulvodynia), that a Pain Doctor has. This means that GPs are not always able to give an accurate vulvodynia diagnosis. Moreover, their outlook on a broad range of treatment possibilities may be limited.

References

[1]. Prendergast SA. Pelvic Floor Physical Therapy for Vulvodynia: A Clinician’s Guide. Obstet Gynecol Clin North Am. 2017 Sep;44(3):509-522

[2]. National Vulvodynia Association (2024). “Vulvodynia Management.”