One of the common vulvo-vaginal conditions that Pelvic physios treat is Vulvodynia or Vestibulodynia- which literally means pain in the vulva or pain in the vestibule respectively.
Some common symptoms of Vestibulodynia are :
- Pain with initial penetration
- Raw, burning, stabbing, itching sensation
- Inability to wear an underwear
- Excruciating pain with just touching the area
Causes for vestibulodynia can be:
- Hormonal: Vestibule is a hormonally dependent structure, meaning for its proper functioning it requires both estrogen and testosterone. Therefore, any condition that reduces these hormones can potentially cause Vestibulodynia. E.g. pain started after taking combined birth control pills. use of Tamoxifen, Spironolactone, and removal of the ovaries
- Inflammatory: Chronic infections, severe allergic reactions from toilet paper, bath products, etc. People may have “sensitive skin”
- Neuroproliferative: This means an increased number of nerve endings increased the sensitivity in the area.
- Congenital or acquired: persistent infection, recurrent allergic reaction, and persistent inflammation can increase the number of nerve fibers in the vestibule
- Overactive Pelvic floor: May be associated with bladder or bowel symptoms such as urgency/ frequency, and constipation. When pelvic floor muscles are the cause, the pain is usually limited to the lower part of the vestibule, i.e. 6 O’clock position
Another common condition is Lichen Sclerosus. This an autoimmune skin condition that causes skin atrophy, hypo-pigmentation (whitening), and scarring, which results in a loss of skin elasticity, making it more susceptible to tearing. Lichen sclerosus can make intercourse painful, as the vigorous force from the activity can cause the atrophic skin to tear. This can also result in pelvic floor muscle guarding against the pain, which can eventually turn into a full-blown Pelvic Floor Dysfunction. Therefore, pelvic physical therapy can be a highly effective adjunct therapy in Lichen Sclerosus to manage pain, reduce tearing by helping scar remodeling and reduce pelvic floor tension.