Vulvodynia, clitorodynia, and vestibulodynia are terms that describe different types of chronic pelvic pain affecting the vulvar region. These conditions can significantly impact a person’s quality of life, leading to discomfort, anxiety, and a decreased desire for intimacy. Understanding their underlying mechanisms is crucial for effective treatment and management.
Vulvodynia refers to generalized vulvar pain that can occur without an identifiable cause. This can manifest as burning, stinging, or irritation and may last for months or even years.
Clitorodynia specifically refers to pain localized to the clitoris, which may occur during sexual activity or even at rest.
Vestibulodynia involves pain at the vaginal vestibule, often triggered by touch, pressure, or sexual activity. This condition is often associated with conditions like provoked vestibulodynia.
Hormonal fluctuations, particularly involving estrogen, progesterone, and androgens, can play a significant role in these conditions. Studies have shown that:
Estrogen Levels: Low estrogen can lead to thinning of the vulvar epithelium and vaginal dryness, which may contribute to discomfort and pain during intercourse.
Hormonal Cycles: Many women report variations in their symptoms in relation to their menstrual cycles, suggesting that hormonal changes may exacerbate or alleviate pain.
Menopause: The transition to menopause can be a critical period for many, as the decline in hormone levels often correlates with increased vulvar pain and discomfort.
Other factors could be:
Endometriosis: Endometriosis can cause chronic pelvic pain and inflammation. If the tissue grows near the vaginal walls or other pelvic organs, it can irritate surrounding tissues, leading to symptoms like burning or discomfort in the vaginal area.
PCOS: Elevated androgen levels can lead to changes in the vaginal environment, such as increased oil production or dryness, which might cause irritation and burning sensations.
Metabolic Syndrome: Insulin resistance and other metabolic abnormalities can affect hormone levels, potentially leading to vaginal dryness or irritation, which may cause a burning sensation.
The nervous system also plays a crucial role in the experience of pain:
Central Sensitization: Chronic pain can change how the central nervous system processes pain signals, making the individual more sensitive to pain (known as central sensitization). This phenomenon is common in chronic pain syndromes, including vulvodynia and related conditions. Think of a fire alarm going off and alerting the whole household, although you were just making toast. By no means are we saying it’s in your head, instead, at Pelvic Connections, we use brain-therapy such as graded motor imagery and Left Right Discrimination which consists of using flash cards to review images of the left and right side of our pelvis.
Nerve Sensitivity: Increased sensitivity of the pudendal nerve, which supplies sensation to the vulva, may result in heightened pain responses even to normal stimuli.
Psychosocial Factors: Anxiety, depression, and stress can further exacerbate pain responses, making an understanding of the nervous system's role essential in treating these conditions.
Musculoskeletal issues can also contribute to pelvic pain:
Pelvic Floor Dysfunction: Tightness or dysfunction in the pelvic floor muscles can lead to pain in the vulvar region. Physical therapy focused on pelvic floor rehabilitation can often provide relief.
Posture and Alignment: Poor posture and alignment can affect pelvic floor function, leading to tension and discomfort. A holistic approach that includes orthopedic assessment may be beneficial to evaluate if there is an imbalance of the pelvis and hip, prolonged compression to the nerve or sacrum - 4 areas this nerve can be compressed. We are experts!
Most Susceptible Posture Types:
Tucked butt, forward head, scrunched toes
Skin conditions can also be significant contributors to vulvar pain:
Vulvar Contact Dermatitis or Allergies: Conditions such as contact dermatitis or allergies to soaps, detergents, or hygiene products can lead to inflammation and pain.
Infections: Fungal infections, bacterial vaginosis, and sexually transmitted infections can mimic or exacerbate symptoms of vulvodynia, making a thorough dermatological evaluation critical.
Microbiome/Inflammation: Constipation, use of LT antibiotics, not using the best lube
Inflammation: Hot topic, what does it mean? Common reasons (in the US): dairy, lack of movement/muscle contraction, sleep hygiene, hormonal balance, high levels of emotional stress or burnout
Hormonal Imbalance: This means dysregulation in general, use of oral BC, postpartum (especially when breastfeeding), perimenopause (35 and on), and postmenopause.
Why we are different: We help screen for this and then help treat the root cause such as advocating for up-to-date research on the use of HRT, addressing constipation, getting an efficient period cycle, addressing sugars and insulin sensitivity, etc. Pelvic health rehab collides with health coaching, nutrition, and more. Although physical therapists cannot diagnose or prescribe, we can provide you with all the real up-to-date information to use and advocate for yourself at your doctor. We also have relationships with great doctors in the area who are familiar with these topics, saving you the frustration of this process
When assessing vulvodynia, clitorodynia, and vestibulodynia, a thorough differential diagnosis is essential:
Ruling Out Other Conditions: Conditions such as vulvar lichen sclerosus, herpes simplex virus, or even psychological disorders can present similarly and must be excluded to provide appropriate treatment.
Holistic Approach: Integrating insights from gynecology, urology, dermatology, and psychology can help create a comprehensive treatment plan that addresses all potential contributing factors.
Understanding vulvodynia, clitorodynia, and vestibulodynia require a multi-faceted approach that considers hormonal, nervous system, orthopedic, and dermatological factors.
A careful differential diagnosis is crucial for effective management. Those experiencing chronic vulvar pain should seek a supportive healthcare team that understands the complexities of these conditions, paving the way for a path toward relief and improved quality of life.
We need to treat people from a whole-body perspective. If we only look at the pelvic floor muscles as pelvic floor therapists, we will be missing so much! We need to get specific and by asking you in-depth questions about all areas of your life, we can help you best.
