When problems happen down there, discussions around the problem can feel overwhelming, slightly embarrassing, and generally difficult to describe. Plenty of women live their lives holding in this big old secret: they either have pain around their vulva (outer or inner labia) or inside their vagina/pelvic floor leading to painful sex, difficulty sitting, problems wearing tight clothing, and/or general anxiety and confusion. Actually, the statistics don’t lie, it’s estimated that around 5-17% of women in the US present clinically with vaginismus (pain in the vagina) whereas 4-16% experience pain or soreness around their vulva. I do question the rather large range in these statistics and ask myself, is this a matter of inadequate statistical data or are medical providers incorrectly taking note of the number of complaints assuming these symptoms are just a “regular female problem”?
But the secrets out now! A good number of women do complain of painful sex and pelvic pain. Plus, physical therapy can help improve these symptoms and reduce pain.
Let’s first clarify the difference between these two similar but technically distinct conditions:
According to the Cleveland Clinic, “Vaginismus is the involuntary tensing or contracting of muscles around the vagina”. These muscles are called your pelvic floor (image below for clarification). Typically, this involuntary contracting happens during sex and is very painful.
According to the Mayo Clinic, “Vulvodynia is chronic pain or discomfort around the opening of your vagina (vulva) for which there’s no identifiable cause (disease or condition) and which lasts at least 3 months”. I’ve added an image here for you to better understand the anatomy of the vulva.
Image source: https://axiawh.com/resources/the-female-anatomy-101/
I hear a lot of stories in the clinic that start with a long-drawn-out tale of women jumping from one gynecologist to the next searching for the cause and reason of their pain. After the doctor discovers that there’s no STD, UTI, or yeast infection involved, a lot of my patients are either sent home with a numbing cream or some sort of anti-anxiety medication to relieve their symptoms. Unfortunately, more often than not, physicians are not referring to pelvic health PT as much as they should. So, by the time my patient comes to see me in the clinic, it’s been months or even years since their symptoms first started. Many of my patients tell me that they only first hear about pelvic PT through either Dr. Google or a best friend/family member. This is is how their healing journey begins.
What should you expect from your first physical therapy session for either of these two conditions?
1. First, your PT will ask you a series of questions about your past medical history (including birth history) as well as specific questions about when and in what condition your pain is aggravated/alleviated.
2. Then your PT will assess the tone (muscle tension) and mobility of your abdomen which is very closely connected to the health and wellness of your pelvic floor via the nervous system.
3. After this, with your consent, your PT will check your tolerance to light touch and deep pressure to the skin of the vulva and the outer layer of the pelvic floor muscles. This can be done through slowly exposing the tissue to a varying degree of either touch or pressure with a technique called graded exposure.
4. Finally, your PT will teach you how you can practice the same technique on your own body at home with either self-touch or with the use of a dilator.
The overall length of healing greatly depends on everyone’s specific symptoms, previous birth history, mental/emotional health, and general physical health. It’s important to know before going into therapy that prognosis can very and there is no one-size -fits-all model. With this being said, there is hope. Healing is possible. I’ve seen many women in the clinic discover more about their bodies throughout the process and eventually finish therapy pain and symptom free.
If you have any questions at all please feel free to reach out.
Make sure to check out my other blog posts all about pelvic health and yoga.