The vulva is what most people colloquially call the vagina. It is the external female genitalia comprising of the labia, clitoris, each of the openings (urethra, vagina, anus), and the skin and muscles surrounding them. Vulvar pain, or vulvodynia, which occurs in around every 1 in 8 women, has a variety of symptom presentations and characteristics.
Vulvodynia is typically:
- Primary or Secondary
- It has always been there since a woman remembers – primary
- It started after something (such as childbirth, surgery, trauma, or infection) – secondary
- Generalized or Localized
- The pain is felt throughout the vulva – generalized
- There are specific points that cause discomfort – localized
- Constant or Provoked
- Persistent in nature – constant
- Brought on by something in particular (tampon or menstrual cup insertion, gynecological exam, sexual activity, prolonged sitting, tight clothing) – provoked
Pain that occurs at the vestibule—the entry way between the vaginal opening and the inner labia—is called vestibulodynia. Pain with sexual activity has a specific term, dyspareunia, but it is often used to describe pain with any type of penetration.
Regardless of the symptom presentation or cause, vulvar pain can most often feel like burning, stabbing, itching, tearing, or stinging. In addition, given the private and intimate region the pain occurs, vulvar pain is commonly associated with feelings of anxiety, distress, shame, and hopelessness. Pain causes anxiety, which causes tension, which causes pain, and so on—a cycle that can be hard to break out of. However, there is hope for improvement, and an empathetic pelvic health physio can be a partner in your healing journey.
Pelvic health physiotherapy is relevant because the vulvar area is rich in nerve fibers that are stimulated by various things, such as different levels of touch or physiological changes in the body (i.e. hormones or inflammation). With vulvar pain, those nerve fibers essentially work too well. In other words, they, along with the nervous system they communicate with, are on high alert, and send alarm signals (interpreted as pain) for things that aren’t typically cause for alarm.
Given nerves communicate with muscles, there is often an understandable guarding or protective muscular response in the vulvar area by the pelvic floor muscles, a group of muscles in the pelvis that are felt when you are trying to hold pee, for example. Vaginismus occurs if the muscles involuntarily spasm to the degree where something cannot go inside (menstrual product, speculum, finger, or penis).
In summary, muscle and nerve function play a role in the perception of pain and the reaction to pain, especially in the vulvar area. What’s worth noting is that if the nervous system can learn to function on high alert, it can eventually relearn to function at a normal level.
Things you can do to restore muscle and nerve function contributing to vulvar pain are:
- Gentle stretches that help “open the pelvis,” such as deep squats, butterfly, happy baby, cat cow, or widened child’s pose.
- Regular but non-threatening self-touch, where you gently press, brush, stroke, or massage areas like the inner thighs, abdomen, and outer labia.
- Regular mindfulness practice, be it yoga, meditation, breathing exercises, being outside, walking, etc.
- Talking about or writing about any negative emotions related to your vulva and/or sex, and thinking about a new narrative to counter those thoughts. (For example, if you feel that your “body is broken,” counter that narrative with “my body is capable of healing.”)
Pelvic health physiotherapy specifically helps address vulvar pain through:
- Treating muscles and surrounding tissue (skin and fascia) in the pelvis, legs, abdomen and hips that contribute to pain and tension.
- Restoring pelvic floor muscle coordination, range of motion, and tone (or tension).
- Providing customized techniques for regulating the nervous system, such as breathing, stretching, sensorimotor remapping, and other mindful practices
- Teaching ways to use tools such a dilators for independent practice and progress
- Providing evidence, resources, and information regarding vulvar and sexual function and health
In addition to muscle and nerve function, vulvodynia can also be related to genetics, hormones (including birth control), inflammatory conditions, a person’s psychosocial context, and other health conditions such as fibromyalgia, IBS, depression, bladder pain or dysfunction, and even TMJ. Thus, healing from vulvar pain is often most effective when it is done through a supportive, interdisciplinary team, in which pelvic health physios play an important role.
We at The Mama’s Physio hope this information is helpful and empowering, and we would consider it a privilege to work with you as you recover.
Please contact our friendly team to get started on your healing journey.
Goldstein, Andrew T., Caroline F. Pukall, Candace Brown, Sophie Bergeron, Amy Stein, and Susan Kellog-Spadt. “Vulvodynia: Assessment and Treatment.” The Journal of Sexual Medicine 13 no. 4 (2016): 572-90.
Morin, Melanie, Carrol Marie-Soleil, and Sophie Bergeron. “Systematic Review of the Effectiveness of Physical Therapy Modalities in Women with Provoked Vestibulodynia.” Sexual Medicine Reviews 5 no. 3 (2017): 295-322.
“National Vulvodynia Association.” National Vulvodynia Association, 2019. https://www.nva.org/.
Vandyken, Carolyn, and Nelly Faghani. “Level 2/3 Female and Male Pelvic Pain: Clinical Skills for Treating Pain.” Vaughan, Ontario, January 10-13, 2019.