Vulvar Pain and Pelvic Floor Dysfunction go together.

Photo of red silk cloth in the shape of a vulva and representing that Vulvar pain, vulvodynia and pelvic floor dysfunction go together

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.  Our licensed physical therapists treat women who come to us after suffering with vulvar pain and vulvodynia for prolonged periods or in the acute stages.  Unfortunately, by the time most patients learn that PT can help their vulvodynia and pelvic floor dysfunction, they have 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.  If this is your circumstance, our pelvic PT for vulvar pain and pelvic floor dysfunction is gentle, compassionate, effective and natural.  If you would like to learn more about our PT program to treat vulvodynia, pelvic floor dysfunction and other pelvic conditions, call us today at (616) 516-4334 or contact us here. 

When a person has vulvar pain, pelvic floor dysfunction is typically also present. 

The pelvic floor muscles have both superficial and deep muscles.  If you have vulvodynia, vulvar pain, persistent genital arousal disorder, perineal scarring (from giving birth) or other vulvar pain condition, the pelvic floor muscles in that region tend to go into a stiff, tense state.  This pelvic floor muscle dysfunction further contributes to your pain and makes it harder to resolve vulvodynia.  Our licensed PTs specialize in gently assessing and treating pelvic floor dysfunction.  We have specific manual therapy and exercise-based techniques that alleviate pelvic pain and pelvic floor dysfunction.  Because we are a specialty PT clinic, devoted to treating pelvic pain, our PTs have experienced and have also undertaken extensive post-graduate training in treating vulvodynia, PGAD, dyspareunia, vaginismus, pudendal neuralgia, scar tissue treatment and other pelvic pain condition.  If you are interested in inquiring about cost and availability of our PT for vulvodynia, call us at (616) 516-4334 or contact us here. 

Our pelvic health physical therapists specialize in treating vulvodynia, vulvar pain, lichen sclerosus, vaginismus, persistent genital arousal disorder, pudendal neuralgia, vulvar pain associated with perineal tearing and other associated vulvar pain conditions.

We provide you therapeutic and comprehensive, whole-body treatment to calm down your pelvic pain and vulvodynia.  To learn more about our treatment, call us today at (616) 516-4334 or submit your questions here.

When working with Purple Mountain Physical Therapy for pelvic PT to help vulvar pain and vulvodynia, you can expect:

*Compassionate, trauma informed therapy that includes gentle and specialized hands-on techniques to your spine, abdomen, hips, thighs and pelvic region.

*Gentle Manual Therapies including Myofascial release, visceral mobilization (abdominal massage), gentle joint mobilization to your back and hips, trigger point release, therapeutic massage to the thighs, hips and back, and pelvic floor muscle manual therapies (external or internal, depending on your needs, preferences and abilities).

*Exercise based care that restores posture, mobilizes fascia and muscles, improves low back and hip mobility, addresses balance, works to enhance nerve and fascia mobility and eases pain.

*A do-able and focused self-care home program.  Our vulvodynia and vulvar pain patients tell us this is very helpful so they can understand what to do to help themselves.

*Education regarding your condition, what we are finding, how it is improving, what to expect in PT and long-term

*Treatment to improve pelvic floor dysfunction, pinched nerves, spine and hip issues, abdominal wall tension, adhesions or scar tissue. 

Our pelvic physical therapy patients tell us they are so grateful to finally experience relief of vulvar pain!

Following an appointment, it is common that patients tell us they feel improvement.  The process of resolving vulvodynia, persistent vulvar pain or other associated vulvar pain conditions does take time and it is our goal to partner with you to find a path forward. Because we specialize in chronic pelvic pain, our licensed PTs have experience and advanced training in providing treatment for your vulvodynia, PGAD, lichen sclerosus, pudendal neuralgia, perineal tearing (from vaginal birth) or other pelvic pain condition.  If you are interested in learning more about our pelvic physical therapy to help vulvodynia, pelvic floor dysfunction and pelvic pain, reach out to us at (616) 516-4334 or contact us here. 

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.  If you are interested in talking to one of our knowledgeable staff members about our PT evaluation for vulvodynia or to inquire about cost and availability, reach out to us at (616) 516-4334 or contact us here

Some of the other things that we screen for and may be going on include:

  • Other pain conditions:  It is common and found in the literature that individuals who have vulvodynia or chronic pelvic pain may also experience other painful conditions. We evaluate you for things such as painful bladder syndrome (interstitial cystitis), 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? We know that lichen sclerosus is inflammatory and many of the chronic pelvic pain conditions are, also.  Our PTs will help advise you on natural things you can do to reduce your inflammatory load, including diet, sleep, heart rate variability training, meditation, exercise or other self-care things.
  • 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) is also assessed and treated by our pelvic PTs. Because we are fully trained orthopedic physical therapists who specialize in pelvic health, spine, neck and TM joint pain, we will treat any orthopedic problem you have. We have found that, indeed, treating things like your stiff ankle or bad back are very important to helping you resolve pelvic pain.  If you are interested in learning more about our pelvic physical therapy to help vulvodynia, pelvic floor dysfunction and pelvic pain, reach out to us at (616) 516-4334 or contact us here.
  • Neurologic conditions, either in the central or peripheral nervous system.
  • Neuroproliferation:  This is a common for vulvar pain.  One reason you hurt may be that you have more nerves in that region than someone who doesn’t experience pain.  Our treatments for vulvodynia are specifically designed to be gentle and therapeutic to enhance the health of your nerves and reduce pinched nerve irritation.
  • Psychosocial factors:  We take into consideration you, as a whole person. We like to understand your lifestyle, activities you enjoy, your goals and stressors.  Having vulvodynia or vaginismus is no picnic and we understand that you may also experience things such as anxiety, depression or mood changes.  Our PTs are here to support you towards feeling like yourself again and can help you find a counselor who is a good fit for you, if this would be helpful. We also consider your cultural beliefs regarding sexual health, coping style, interpersonal relationships and sexual function.  We provide compassionate and trauma-informed care, so you can expect to be treated with respect and dignity

If you are interested in learning more about our pelvic physical therapy to help vulvodynia, pelvic floor dysfunction and pelvic pain, reach out to us at (616) 516-4334 or contact us here. 

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.  If you are interested in learning more about our pelvic physical therapy to help vulvodynia, pelvic floor dysfunction and pelvic pain, reach out to us at (616) 516-4334 or contact us here.

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

Research has studied this and has found there are connections with vulvar pain conditions and having allergies or exposure to common preservatives in beauty products.

  • 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 hygiene habits provide long-term and repeated exposure to MI and are risk factors for developing vulvar pain?

Because vulvar pain and pelvic floor dysfunction go together, alleviating your pelvic floor muscle tension will reduce your vulvar pain.  

If the pelvic floor muscles are stiff, tight or in spasm, this hurts.  It also reduces blood flow and can impair the nerves that go to the vulva.  Our pelvic physical therapy treatment for vulvodynia and pelvic floor dysfunction is designed to restore your entire pelvis, back, hips and abdomen.  We treat you wholistically and work with you to establish goals and determine underlying contributions to your vulvodynia that we can improve this includes treating pelvic floor dysfunction because we know that vulvar pain and pelvic floor dysfunction coexist.  Because there are many things contributing to your condition, we work very diligently to provide you treatment that identifies and treats these many things.  If you would like more information about working with our physical therapists, whether in-person in Grand Rapids, Michigan or via an online consultation, contact us here or call us today at 616-516-4334.

Physical Therapy for provoked vulvodynia has been found to reduce pain

A recent small study confirms what our PTs have found:  PT can help decrease vulvar pain.  

“The average pain scores of the 24 participants reduced significantly after therapy, and 42% had no pain between treatment and the time of survey. Eighty-three percent did not undergo additional treatment after the initial physical therapy and reported high or very extremely high levels of pain reduction following treatment.

Physical therapy is an effective long-term treatment for primary or secondary PV, resulting in pain reduction and improved sexual function.”

Jahshan-Doukhy O, Bornstein J. Long-Term Efficacy of Physical Therapy for Localized Provoked Vulvodynia. Int J Womens Health. 2021 Feb 10;13:161-168. doi: 10.2147/IJWH.S297389. PMID: 33603495; PMCID: PMC7882794.

Pelvic PT for vulvodynia, pelvic floor dysfunction, vulvar pain and all pelvic health conditions can include:

  • 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 gently 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. If you are interested in talking to one of our knowledgeable staff members to answer your questions about pelvic PT for vulvodynia and pelvic floor dysfunction, call us at (616) 516-4334 or contact us here.
  • 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?

It is important that you find a medical provider who is specially trained in treating vulvar pain conditions.  Medical providers will give you the diagnosis, prescriptions, biopsies and surgical options (if there are any) that may help you.  Be careful in looking for an experienced provider.  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.  Professional societies like The International Pelvic Pain Society or NAMS (The North American Menopause Society) have find a provider directories that may be a helpful resource.

Our physical therapy offers a natural, comprehensive adjunct care to support you and help you achieve true pain relief. 

Medical management by physicians tends to include medication, biopsies and sometimes (not often) surgery.  By improving your blood flow to the area, resolving pelvic floor dysfunction, optimizing your bladder and bowel, correcting your posture, enhancing your fascia, nerves, joints and strength, our pelvic health physical therapy treatment is designed to help you feel better. And, the best part, in addition to pain relief, is that our pelvic PT treatment does not have the side-effects that things like medication and surgery cause.  If you are interested in speaking with one of our staff members to inquire about cost and availability of our pelvic PTs, call us today at 616-516-4334 or contact us here.

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 for you to see everything at the same time as the physician.  You have the right to decline an internal exam, if this is too painful for you.  You physician will likely prescribe medications and sometimes will take a biopsy to confirm your diagnosis.

If a pelvic PT examines me, how is this different than what a physician does?

Our physical therapists spend one hour with you, one-on-one to take a comprehensive history and examination.  Our pelvic physical therapy exam includes a musculoskeletal assessment of your body, pelvic exam and assessment of bladder and bowel issues.  In addition to these things we:

*Discuss what provokes your pain

*Assess and treat bladder, bowel and prolapse symptoms.

*Assess and treat your spine, hips, thighs and abdomen because problems here can contribute to vulvar pain and pelvic floor dysfunction

*If you permit a vulvar and vaginal exam, we proceed very gently and begin with visual inspection of your tissues.

*We look for a variety of things in the vulva and vestibule, including the pelvic floor muscles, nerve irritation, the color of your skin, the growth (or lack of) of hair, signs of inflammation, fibrosis, adhesions, Bartholin’s glands issues and more.

*We want to see if your labia minora and majora are clearly defined, or do you have structural changes in these areas?

*You will receive a Q-tip test, which gently applies a Q-tip to touch very specific areas of your vulva and vestibule.  We ask you whether it hurts or not.  The specific areas where you have pain give us clues about what is generating your pain.

*A complete pelvic floor muscles assessment (either external or internally, depending on your comfort).  We assess your superficial and deep pelvic floor muscles for signs of tension, weakness, trigger points and dysfunction.

*We examine your vulva, vestibule, clitoral hood and look for remnants of hymen.  This is all very gentle and conducted with your permission, while educating you and explaining everything we are finding.

If you would like to speak with one of our staff members about your condition to determine if we may be able to help you, contact us here or call us today at (616) 516-4334.

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 are 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 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 fissures 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.  Our pelvic physical therapists treat lichen sclerosus and we’ve written more detail about that care here.  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.  If you have lichen sclerosus and would like information about pelvic physical therapy to treat your LS, reach out to us here or call our office to talk to one of our staff members, 616-516-4334.

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

We help women overcome their vulvar pain and learn what to do at home to help pelvic pain and vulvar pain.  Having helped individuals with persistent pelvic pain, our pelvic health PTs provide you the experience and compassionate care you deserve.  Our whole-body treatment approach and ability to improve pelvic floor dysfunction and pelvic pain is likely quite different & more comprehensive than what you have tried.  If you are wondering if we may be able to help you and want to learn more, contact us at 616-516-4334 to speak with one of our knowledgeable staff.  Before scheduling an appointment, we can discuss 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, pelvic pain, back, neck and TM joint disorder clinic.   Our PTs provide therapeutic 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.

Peace,

Dr. Maureen O’Keefe, DPT specializing in treatment for pelvic pain, pelvic floor dysfunction, vulvar pain, TM joint disorders and back pain

To read more about our clinc and treatment, you may be interested in these articles

Vaginismus and Dyspareunia Treatment in Grand Rapids

Physical Therapy for Lichen Sclerosus

What Can Pelvic Floor Physical Therapy Help With?

Physical Therapy Resolves Vaginismus and Dyspareunia

 

References:

Jahshan-Doukhy O, Bornstein J. Long-Term Efficacy of Physical Therapy for Localized Provoked Vulvodynia. Int J Womens Health. 2021 Feb 10;13:161-168. doi: 10.2147/IJWH.S297389. PMID: 33603495; PMCID: PMC7882794.

Kline JM, Arriaga-Gomez E, Yangdon T, Boo B, Landry J, Saldías-Montivero M, Neamonitaki N, Mengistu H, Silverio S, Zacheis H, Pasha D, Martinov T, Fife BT, Chatterjea D. Repeated dermal application of the common preservative methylisothiazolinone triggers local inflammation, T cell influx, and prolonged mast cell-dependent tactile sensitivity in mice. PLoS One. 2020 Oct 26;15(10):e0241218. doi: 10.1371/journal.pone.0241218. PMID: 33104726; PMCID: PMC7588120.

Loflin BJ, Westmoreland K, Williams NT. Vulvodynia: A Review of the Literature. J Pharm Technol. 2019 Feb;35(1):11-24. doi: 10.1177/8755122518793256. Epub 2018 Aug 20. PMID: 34861006; PMCID: PMC6313270.

Morin M, Carroll MS, Bergeron S. Systematic review of the effectiveness of physical therapy modalities in women with provoked vestibulodyniaSex Med Rev. 2017;5:295–322. doi: 10.1016/j.sxmr.2017.02.003