• Lila Abbate, PT, DPT, MS, OCS, WCS

Vestibulodynia: Treatment with Pelvic Floor PT

Vestibulodynia is pain at the entrance of the vagina. Pain is often activated by touch and is categorized as vestibulodynia when problems persist for more than three months with no underlying causes.(5) Oftentimes, it’s described as a burning sensation at the entrance felt upon touch or insertion, even by a tampon or tight-fitting clothing, and can cause sexual difficulties as well as emotional and psychological distress.(4)


Physical therapy is the recommended first-line treatment for patients experiencing vestibulodynia. Many patients with this condition have simultaneous pelvic floor muscle dysfunction and treating these muscles can help prevent further complications.(5) Pelvic floor muscles are both superficial and deep; and help with many bodily functions like using the bathroom, breathing, and sexual activity. The pelvic floor muscles in women with vestibulodynia are found to be stiffer and lack strength compared to women without this diagnosis.(1)


Vestibulodynia can occur at any age, from adolescent to post-menopausal women. As age increases, however, there is the possibility that the pain is a result of lowered estrogen levels and subsequent vaginal atrophy, particularly in the post-menopausal population.

The good news is that improving the strength and tone of pelvic floor muscles is possible with the guidance of a skilled pelvic PT. Treatment includes a variety of modalities including vaginal dilators, biofeedback, manual therapies, neuromuscular reeducation and an interdisciplinary approach with other medical and psychological health providers.(3) As non-invasive treatments are almost always preferred, the best place to start is with an experienced pelvic physical therapist who can educate you on all possible options.(6)


Chronic pain conditions often also bring on additional psychological symptoms of anxiety, depression, and fear of the pain itself.(4) While research shows that physical therapy is the most effective treatment for vulvar pain, we always support patients utilizing an integrated medical approach. Some patients find that working with a psychotherapist increases their success, others prefer the aid of a medical doctor, and some utilize all available options.(4) We are always happy to work as a part of your treatment team to relieve your pain and improve your quality of life.


We are New Dimensions Physical Therapy understand that vestibuoldynia is disruptive and uncomfortable, but many patients do recover and regain healthy vaginal function from available treatment options. Contact us today to set up your evaluation and find out if pelvic floor PT is right for you!


Sources:

  1. Morin, M., Binik, Y. M., Bourbonnais, D., Khalifé, S., Ouellet, S., & Bergeron, S. (2017). Heightened Pelvic Floor Muscle Tone and Altered Contractility in Women With Provoked Vestibulodynia. The Journal of Sexual Medicine, 14(4), 592–600. doi: 10.1016/j.jsxm.2017.02.012

  2. Goldfinger, C., Pukall, C. F., Thibault-Gagnon, S., Mclean, L., & Chamberlain, S. (2016). Effectiveness of Cognitive-Behavioral Therapy and Physical Therapy for Provoked Vestibulodynia: A Randomized Pilot Study. The Journal of Sexual Medicine, 13(1), 88–94. doi: 10.1016/j.jsxm.2015.12.003

  3. Morin, M., Carroll, M.-S., & Bergeron, S. (2017). Systematic Review of the Effectiveness of Physical Therapy Modalities in Women With Provoked Vestibulodynia. Sexual Medicine Reviews, 5(3), 295–322. doi: 10.1016/j.sxmr.2017.02.003

  4. Morin, M., Dumoulin, C., Bergeron, S., Mayrand, M.-H., Khalifé, S., Waddell, G., & Dubois, M.-F. (2016). Randomized clinical trial of multimodal physiotherapy treatment compared to overnight lidocaine ointment in women with provoked vestibulodynia: Design and methods. Contemporary Clinical Trials, 46, 52–59. doi: 10.1016/j.cct.2015.11.013

  5. Lev-Sagie, A., & Witkin, S. S. (2016). Recent advances in understanding provoked vestibulodynia. F1000Research, 5, 2581. doi: 10.12688/f1000research.9603.1

  6. Vieira-Baptista, P., Donders, G., Margesson, L., Edwards, L., Haefner, H. K., & Pérez-López, F. R. (2018). Diagnosis and management of vulvodynia in postmenopausal women. Maturitas, 108, 84–94. doi: 10.1016/j.maturitas.2017.11.003

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