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What is vulvodynia?

Updated: Oct 11, 2023

Before delving into what Vulvodynia is, let's have an anatomy lesson focusing on the vulva. The vulva constitutes the external genitalia for individuals with a vagina. It is crucial to differentiate between the vulva and the vagina, as the latter term is often used colloquially to refer to both inner and outer structures. Encouraging the use of correct terminology, even from a young age, can help eliminate shame and embarrassment surrounding these anatomical terms.

The vulva serves to protect the vagina and urethra and plays a significant role in the sexual response for women. It encompasses various structures, such as the labia (outer and inner), clitoris, mons pubis, vestibule, and everything in between. Understanding the vulva's anatomy is essential for discussing vulvodynia, which can involve the following symptoms to the vulva region:

  • Pain

  • Burning

  • Stinging

  • Itching

  • Irritation

Vulvodynia is categorized as a chronic pain condition persisting for over three months and lacks a known cause.

Subcategories of Vulvodynia include:

  • Clitorodynia (pain in the clitoris)

  • Vestibulodynia (pain in the vestibule region of the vulva)

Regardless of the pain's specific location or type, individuals with vulvodynia experience chronic discomfort and often suffer from anxiety. Activities such as wearing tight underwear or pants become uncomfortable, and vaginal penetration is usually painful. Additionally, they may experience vaginal pressure, burning, and urinary symptoms such as urgency, increased frequency, incomplete emptying, a burning sensation during urination, and light bladder leakage.

What causes vulvodynia?

Vulvodynia is classified as having an unknown cause. However, potential factors associated with the condition include:

  • Hormonal imbalances: The vestibule is highly sensitive to estrogen and androgens, and imbalances can result in irritation.

  • Musculoskeletal components: Approximately 90% of individuals with vulvodynia exhibit overactive pelvic floor muscles. Other myofascial and biomechanical factors can also contribute to vulvar pain.

  • Inflammatory conditions: Conditions like Lichen sclerosus and Lichen planus may contribute to vulvodynia.

  • Infections: Recurring infections like bacterial vaginosis and thrush may play a role.

  • Nerve-related factors: Neuroproliferation (excessive nerve endings in the area) or irritation to the nerves supplying the vulva, such as the pudendal nerve, can contribute to pain.

  • Iatrogenic causes: Vulvodynia may arise due to medical procedures, postoperative pain, cancer treatment, hormone therapy, trauma, or lacerations associated with childbirth or genital mutilation.

How do we treat vulvodynia?

Firstly, any infections or inflammatory conditions need to be identified and managed by a gynaecologist or specialist.

Our Osteopaths, who have a special interest in vulvodynia, use a combination of techniques, including internal pelvic floor myofascial release (if appropriate and of course with consent), to decompress the pudendal nerve and alleviate tension in overactive pelvic floor muscles. External bodywork targets the fascia leading to the vulva, as well as the muscles, nerves, and joints influencing this area.

Given that vulvodynia is a chronic pain condition with an over-stimulated nervous system, part of the treatment involves using gentle osteopathic techniques to calm the nervous system. We recognise that whole body treatment and cranial osteopathy is an amazing adjunct to pelvic floor therapy.

Additionally, we provide lifestyle advice, breathing pattern guidance, prescribe movement practices, and incorporate mindfulness techniques into the treatment plan.


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