Vaginal Pain Conditions
As a pelvic floor physiotherapist, I have had many conversations with friends, patients and colleagues about subjects that a lot of people don’t normally talk about. An often-heard complaint is of vaginal pain – whether during exercise or sexual intercourse, after childbirth, post-menopause, or even just while sitting at a desk.
Signs & Symptoms
Vaginal pain can be referred to in different ways: vaginismus, vulvar vestibulitis, dyspareunia (painful intercourse), or most commonly, vestibulodynia. Provoked vulvar vestibulodynia – PVD (the opening of the vagina is called the “vestibule”, and the suffix “-dynia” means pain) – is somewhat of a catch-all term for different types of vaginal pain which occurs in the absence of more serious causes, and is very common. Symptoms can vary, but often include: pain with tampon use or medical exams, pain with penetration during sexual intercourse (dyspareunia), irritation from a pant seam, or pain during cycling. Some patients experience pain without any provocation at all (unprovoked vulvar vestibulodynia). Patients often report a dry, raw, scratchy, knife-like, or burning sensation. The difficulty is that despite it being so common, it is often normalized as a non-issue even when it is talked about. Symptoms can be dismissed as normal when medical testing comes back negative (for example, for urinary, yeast, or sexually transmitted infections). Other people believe that pain is a normal, expected consequence after pregnancy and childbirth. In reality, no one should have to suffer through these symptoms, and there IS something that can be done about it!
Treatment for this type of condition involves education to help patients understand what is happening and how they can make changes to decrease or eliminate pain. With vestibulodynia, the nervous system has become sensitized – treatment for this is similar to treatment for any other pain condition elsewhere in the body, in that the goal is to desensitize the nervous system and restore proper functioning of the body’s pain alarm. This will often involve exercises to improve control and proprioception of the pelvic floor muscles. Pain often leads to protective guarding of the muscles, which can cause further pain and perpetuates this cycle.
There are many different reasons why a patient might experience vaginal pain, but help is available. As with the other body aches and pains that physiotherapists treat, our goal is to help our patients to return to the activities they enjoy. Having an education-focused treatment plan can not only reduce the stigma associated with discussions regarding women’s health issues, but can also reduce barriers to receiving treatment. Contact your physician and/or pelvic floor physiotherapist if you have more questions about pain that is preventing you from enjoying your regular activities.
Written by Melina Mirzaei