Vulvar Pain and Pelvic Floor Dysfunction go together.

Vulvar pain, vulvodynia

If you have Persistent Vulvar Pain or Vulvodynia and are looking for an experienced pelvic health physical therapist to help you, you’ve found the right place.

Vulvar pain is a challenging and frustrating condition to experience.  We treat women who come to us after suffering with vulvar pain for prolonged periods.  By the time a woman finds us, she usually has had pain with sex for quite a long time, sometimes has pain with wearing clothing that touches the vulva and may experience worse pain with basic activities, like sitting.  When a person has vulvar pain, pelvic floor dysfunction is typically also present.

We Begin Your Vulvar Pain Treatment with a Detailed Evaluation to Determine Contributing Causes, such as Pelvic Floor Dysfunction

With vulvovaginal pain there tends to be many things going on.  Rarely is there only one problem:  the vulvar pain.  There are usually other things happening and because of this we like to partner with your other providers so that you are receiving comprehensive care.  Some of the other things that we screen for and may be going on include:

  • Other pain conditions, such as painful bladder syndrome, fibromyalgia, irritable bowel syndrome, TM joint disorder or migraines.  Pelvic health PT can help your other pain conditions.  In fact, TM joint dysfunction is so common in pelvic patients that we have a program to evaluate and treat this for our patients.
  • Hormonal issues such as thyroid problems, infertility, blood glucose issues, perimenopause or menopausal status, PCOS.
  • Inflammation:  this is very common.  In our evaluation we try to identify if this person has any signs or symptoms of inflammation anywhere else.  Do they have gut bloating? Tendinitis? Skin conditions?  Allergies?
  • Musculoskeletal problems: This is a primary area for physical therapy to help you.  With vulvar pain there is typically pelvic floor dysfunction.  There also may be myofascial restrictions in the abdomen, spine, hips or thighs.  Underlying biomechanical problems in your hips, back or elsewhere need to be addressed.  Any scar tissue (C-section, hernia scars, other abdominal, back or hip surgeries)
  • Neurologic conditions, either in the central or peripheral nervous system.
  • Neuroproliferation:  this is a big one for vulvar pain.
  • Psychosocial factors:  anxiety, depression, mood, cultural beliefs regarding sexual health, coping style, interpersonal relationships, sexual function

The vulvar tissue is sensitive, keep products away from it that can bother it!

If you have persistent vulvar pain or painful sex, we will talk about nutrition, vulvar hygiene, gut/immune health and exposure to common household chemicals.  Vulvovaginal pain, burning and dyspareunia can have numerous causes, so it is important to see a specialist physician who can check out your tissues and determine what is going on.  Many of these causes have been found to have an inflammatory component, which is why wholistic healing approaches can be warranted.  Doing things that reduce your body’s inflammation, keep your allergies in check, eliminate exposure to household chemical irritants and optimize your gut and immune health can be important components of getting your vulvodynia, vulvovaginal pain, burning and dyspareunia (painful sex) to improve.

It is Spring & Allergies are here!  Might you be experiencing Allergy-Driven Genital pain?

Research has studied this and has found there are connections.

  • One common preservative has been found to be problematic and may be in your body care and cosmetic products. It is commonly used in shampoo, conditioner, hair color, body wash, lotion, sunscreen. Methylisothiazolinone (MI) is a preservative that is found in a wide array of liquid cosmetics, personal care products and cleaning products on the market today. Its function is to inhibit the growth of bacteria.
  • Did you know that occupational exposures (via salon work, housecleaning, yard maintenance etc.) and household hygience habits provide long-term and repeated exposure to MI and are risk factors for developing vulvar pain?
  • Interested in reading the science about MI, here’s a link:

What will pelvic floor PT do for my vulvar pain?

We treat you wholistically and work with you to establish goals and determine underlying contributions to your vulvodynia that we can improve.  Because there are many things contributing to your condition, we work very diligently to provide you treatment that identifies and treats these many things.  This means:

  • We assess your fascia throughout your body, because we know there are fascial restrictions that may be far away from your vulva that can be part of your problem.
  • We treat your joints, especially in your back and hips to make certain you have optimal, full range of motion in each joint so that the nerves and muscles that enter the vulva and pelvis have optimal pathways.
  • We treat your pelvic floor, in a very gentle and detailed way.  You have several layers of pelvic floor muscles and we work specifically to determine what is the problem and how to treat them.
  • We treat your connective tissue around your vulva.  This is an important piece, especially if you have Lichen Sclerosus and are developing adhesions that could compromise your clitoris and vaginal opening.
  • We teach you how to stop clenching and holding the vulvar region tight and stiff.   This is a natural consequence of being in pain, but we need to reverse this problem so that the region can restore blood flow, be less clenched and relax.
  • We help you achieve your goals, whether they are to sit without pain, to experience intimacy again, to wear underwear or anything else.
  • We offer an annual pelvic floor wellness check-up for women with chronic vulvar conditions such as lichen sclerosus and vulvodynia.  Especially if you have lichen sclerosus, an annual check up to examine your tissues and advise you on your status and what to do to maintain your pelvic health can be invaluable.  We wrote about our annual pelvic wellness check up here.  Just click here to read more about it.

 How do I find a physician provider who knows how to help me?

Your physician may have very little training in vulvar dermatology and anatomy.  This is true whether your provider is a dermatologist, gynecologist or family medicine practitioner.  Therefore, you need to recognize that if you have persistent vulvovaginal pain you need to go to a provider who specializes in pelvic pain.  This may be a physiatrist, a gynecologist with pelvic pain specialty, a sexual medicine specialist, a vulvodynia specialst, a pain management specialist or a gynecologic oncologist.  The key is to find a provider who often treats women who  have persistent vulvovaginal pain.  That is the question to ask when you schedule your appointment and do your research.  The International Pelvic Pain Society has a provider directory and may be a helpful resource.

If I have vulvar pain, what should I expect my physician to do when I get an exam?

Your physician provider should use a colposcope during your examination.  This is basically like a special magnifying glass to see your vulva and vagina and sometimes there is a computer screen you can watch  so you can see everything at the same time as the physician.  Your provider (& a pelvic health physical therapist) will very gently examine your vulvar area.  We may use a Q-tip applied very delicately in various areas to determine if you have pain and normal sensation.  Where, exactly, you have your pain gives us a lot of clues of what might be causing it.  We like to determine if you have pelvic floor dysfunction in addition to vulvar pain.  In most cases a woman does have both.

Should I get a biopsy?

It is recommended that you get a punch biopsy when you have a lesion or tissue that looks different than expected.  If your tissue does not have any lesions and there is no appearance changes then the biopsy is not recommended.  It is common that some vulvar dermatologic conditions may be misdiagnosed as a yeast infection, vitiligo or herpes and a biopsy will definitively shed light on what condition you have. While recurrent yeast infections do occur, you also may probe your physician if you believe there is something else going on beyond a yeast infection.  Could a biopsy or a good exam determine if there is a an underlying condition going on?

There are various types of conditions that start with the word “lichen”, such as lichen planus, lichen sclerosus and lichen simplex chronicus.  A biopsy helps determine if you have these or other conditions.

Could I have lichen sclerosus?

Lichen sclerosus (LS) is a particular condition where the tissue changes its texture and architecture, tends to get whitish, it may appear crinkly or waxy.  You may have fissues and loss of your labia minora.  You may experience fusion of the tissue over the clitoral hood.  Narrowing of the vaginal opening can occur with this, so tearing may be present during intercourse and sex is generally painful.  More than 30% of people with lichen sclerosus also have an autoimmune disease such as thyroiditis, pernicious anemia, vitiligo and alopecia areata.  If a person has LS there is a 3-6% risk of developing vulvar squamous cell carcinoma, so it is important to do self checks using a mirror so you are familiar with what your vulvar skin looks like and is important to see your provider regularly.   Steroid treatment should be reserved until after a biopsy result comes through because some of these conditions benefit most from steroid treatment, whereas other conditions don’t benefit from steroids and they are actually not good for those conditions.  Clobetasol is the treatment of choice for lichen sclerosus and should be used continuously, as prescribed and optimal use of Clobetasol is the best way to reduce vulvar cancer risk. Once the active disease has been resolved then the adhesions that are narrowing the opening at the vaginal area can be removed.  There is research being performed on the use of platelet rich plasma to treat lichen sclerosus, so that is something to keep your eye on.  Fractional CO2 laser has also had some research for treating vaginal atrophy and LS.

Vulvodynia and persistent vulvovaginal pain is frustrating.  Pelvic PT can help you!

We help women overcome their vulvar pain.  If your provider doesn’t seem to understand your condition, give us a call.  Having helped individuals with persistent pelvic pain for more than 2 decades, Dr. O’Keefe can offer you a pelvic health physical therapy wholistic evaluation and treatment approach that is likely quite different & more comprehensive than what you are currently receiving.  If you are wondering if we may be able to help you and want to learn more, contact us at 616-516-4334 to schedule a free phone consult so we can learn about your condition and see if we think we can help you.  Located in Grand Rapids, Michigan, Purple Mountain Physical Therapy is a specialty pelvic health clinic founded by Dr. Maureen O’Keefe, DPT.  Dr. O’Keefe provides unique and advanced services that are compassionate and patient focused and help get you back to feeling like yourself again. If you are interested in learning more about what we offer call 616-516-4334.


Dr. Maureen O’Keefe, DPT