What is vulvodynia?
Vulvodynia is a condition that at least 10 to 20% of women will experience at some point in their lifetime. It involves the nerves of the vulva (the area outside the vaginal opening) becoming sensitised, which commonly results in a sensation of burning, stinging, rawness, generalised pain or soreness in this area. Physiotherapists can provide advice and exercises to help retrain these nerves (to ‘desensitise’ them) and support the recovery of other muscles in the pelvis that may have been affected, such as your pelvic floor muscles.
The term vulvodynia is used to describe the persistent vulvar discomfort (lasting 3 – 6 months, but often years) when all other potential causes of the pain have been ruled out (such as infection) or the pain has persisted despite adequate management of the original cause (e.g. treatment of vaginal thrush). It can significantly impact quality of life for the many women who suffer with the condition, and is often misdiagnosed or inadequately managed.
In vulvodynia, the nerve endings in the vulval skin and surrounding tissue can become extra sensitive (known as ‘peripheral sensitisation’), as do the neurons in the brain and spinal cord (known as ‘central sensitisation’), which means common, non-painful sensations (such as gentle pressure or stretch, warmth or coolness) can be intensified and are perceived as potentially harmful by the brain. This results in the brain producing a pain response (an ‘output’), which is usually protective and alerts us to danger or harm, such as tissue damage.
However in vulvodynia the brain produces uncomfortable sensations such as pain, burning and stinging in response to non-painful stimuli such as light touch (an ‘input’) at the vulval skin. The surrounding muscles (including the pelvic floor muscles) tense up in response to this pain as a protective mechanism – this can make sex painful or impossible, cause difficulty using tampons or having papsmears and contributes to a number other related problems (for example difficulty emptying your bladder or bowel).
If you are experiencing any of these symptoms and think you may have vulvodynia – it is important to rule out other potential causes of vulvar pain, such as infection, by seeing a medical practitioner (e.g. a GP with a special interest in women’s health). Your GP may refer you to a Gynaecologist for further investigation before you are diagnosed with vulvodynia. Once you have ruled out other causes of your pain, your physiotherapist will work with you to determine the most appropriate management plan, this may include stretches, pelvic floor relaxation exercises, as well as techniques for vulval desensitisation and general vulval care.
A multidisciplinary approach is needed to effectively manage this condition, meaning your physiotherapist will work closely with other health practitioners (most commonly your GP and/or gynaecology or dermatology specialist).
Below we have listed some helpful tips for vulval care – many of these tips are useful for all women to apply in daily life, but they are especially important for those experiencing pain or sensitivity. If you are experiencing any symptoms of vulvar pain, it is important to see your medical practitioner and ensure other causes, such as infection, are ruled out.
Women with vulvodynia should avoid potential irritants, such as:
- Soap and shower gels: only wash the vulva with water and wash the body with a soap-free product such as QV, Cetaphil or Dermaveen.
- Perfumes: water is enough to clean the vulva, do not douche, use sprays or powders on the vulva, avoid using scented products (e.g. toilet paper, pads/liners, body washes, hygiene wipes) and take care when applying perfume to other areas of the body (ensure the vulva is covered).
- Fabric softeners and washing powders: switch these products to low-irritant versions for sensitive skin types.
- Pads and liners: vulvodynia can make women more aware of normal vaginal discharge which means some women may start wearing pads or panty liners, these can cause further skin irritation so are best avoided. If you think you have an increase or change in your vaginal discharge, it is important to see your GP for further assessment.
- Lubricants: switch to natural lubricant such as Olive&Bee intimate cream, olive/coconut oil, or a lubricant that is water based and glycerin, paraben, scent free.
- Underwear made of synthetic fabric: It is important to wear a breathable fabric such as cotton to avoid excessive sweat or moisture in the region (loose fitting types can improve comfort too).
It is also important to avoid drying out the skin which can happen with long showers and baths. If the skin is very dry and a moisturiser is required, use simple low-irritant products in the surrounding area but do not apply directly to the mucosal surfaces/the area immediately surrounding the vaginal opening. If there is an area of fragile or broken skin, this should always be reviewed be your medical caregiver, but while it is healing you may consider using a simple water-resistant barrier ointment (such as Dermeze ointment) for protection (e.g. if wearing pads, if the area is damp from increased discharge or incontinence, or before swimming). This should always be discussed with your medical caregiver.
There is strong evidence to support the role of women health physiotherapists with additional training in women’s and pelvic health to treat a number of conditions across all life stages – from more commonly known pelvic health issues affecting women such as incontinence and prolapse, to pelvic and sexual pain concerns and also for helping children and adolescents with bed wetting or other bladder/bowel control concerns.
We hope the information in this blog has been useful and should always be considered in conjunction with an individual assessment with your physiotherapist and/or other health care provider skilled in the area such as a GP or gynaecologist.
We would love to help you manage your concerns and get you back achieving your goals worry –free!