Vulvodynia is Not a Diagnosis | Vulvar Pain Causes and Treatment
What if I told you that your vulvar pain has been mistreated for the last decade?
By: Julie Sarton, PT, DPT, WCS, Owner & Founder of Sarton Physical Therapy
This was sadly the case for a patient I began treating recently.
Vulvodynia is a symptom, not a diagnosis. When broken down, the term “vulvodynia” just means pain (“-dynia” is a suffix meaning “pain”) in the vulva (“vulvo-”).
Saying you have been diagnosed with vulvodynia is almost equivalent to saying that you have been diagnosed with knee pain. It doesn’t tell you much about what needs to be done to treat the pain. So, you have knee pain. Well, what’s causing it? Only once you get to the root of your pain can you adequately take progressive steps toward healing.
As clinicians and even as patients, we have to start recognizing that there are phenotypes—underlying causes—that exist. Vulvodynia is a term that acts as a descriptor, but the actual phenotype of pain manifestation would be vulvodynia related to pelvic floor muscle spasm, or vulvodynia caused by hormonal insufficiency.
A lot of patients will have multiple causes of Vulvodynia, and it's up to us as the clinician to figure out what those causes are.
For example, I recently saw a patient that has a 11-year history of vulvodynia. She had never been referred to pelvic floor physical therapy in all of that time. She always thought that her reason for vulvodynia was candida, which is yeast. So she would get a yeast infection, and then the the vulvar tissues would become irritated, and she would complain of burning, itching and stinging.
Now, the problem is is that now she does not even get an infection, but she still has the burning, itching and stinging. Why? Over those 11 years, her muscular system has reacted to the chronic disruption in the environment of the vaginal area, the vulva, and the vestibule. Plus, the pudendal nerve, which innervates the pelvis, and the terminal branch that goes to the perineal area and the clitoral area also have become hypersensitive.
As a result of all of this, we now have to address the muscle component, the nerve component, and also make sure she does not have recurrent yeast by ensuring a healthy environment. Additionally, she is now 45 years old, so there have been visible changes with her anatomy that revealed evidence of hormone deficiencies. So, we also are focused on restoring the tissue health and integrity there as well. I am working closely with her physician so we can work together to make sure these changes happen.
Sometimes visuals make complicated concepts clearer. For this patient, I drew this picture:
All of her contributing factors (phenotypes) were:
Pelvic floor muscles
Irritable pudendal nerve
Chronic recurrent yeast infections
Stress (learn more about the pelvic floor / stress connection here)
Hormones
Diet
These are all phenotypes that caused her vulvodynia. In order for the patient in this example to heal, it is not the “vulvodynia” that needs to be treated. Rather, each and every underlying, perpetuating cause need to be addressed.
Please note: vulvodynia pain will vary widely from woman to woman. Symptoms may be primary (possessed consistently for a lifetime) or acquired (periodic, inconsistent pain symptoms).
So what’s the big deal?
The medical term out there right now, vulvodynia, does not tell us much. All it says is that you have burning or irritation in the vulva. This particular patient spent 11 years with doctors who looked only at the medical component of it, for its face value as a descriptor. Her “treatments” for those 11 years were medications of various types, including yeast suppressants, Vitacain (to stop the burning), and an anti-fungal diet. The muscles themselves? Completely ignored. When she came in to us, her pain was down within the first treatment.
I asked the question I always ask,
To which the answer was, and almost always is:
Sure enough, one I went in and palpated, she had significant both superficial and deep muscle spasm.
This patient, though perturbed by 11 years without what she now knows are extremely important pelvic floor physical therapy treatments, now carries a significant amount of hope into her future healing journey.
I guess it’s true what they say…the truth sets you free! Whether you are a patient or clinician, be sure to dig deeper into descriptions of pain to find the (sometimes numerous) underlying causes of it.
The Pelvic Healing team believes healing is multi-modal, and requires a customized treatment plan for best results.
We want to encourage you to get evaluated by one of our outstanding physical therapists, and regain control of your life. Pelvic pain, pelvic floor dysfunction, back pain, tailbone pain—you name it—these conditions do not have to control your life. There is hope. Call us today to book an appointment for 1 of our 3 Southern California locations, or inquire about a virtual, online treatment session.
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