pelvic health, physical therapy, Sex, women's health

Dispelling Dyspareunia Part 2: Vulvodynia

VULVODYNIA: the painful (dynia) vagina (vulva).

Let’s talk about the classifications of this babe:

Generalized: The entire vulva experiences an abnormal sensation. This can be brought on by touch from clothing, hands, with intercourse, etc. or it can happen spontaneously and may always be present. OR you could have a fun mix of both.

An accurate pictoral description: Valerie Fischel/

Localized: Only parts of the vulva experience an abnormal sensation – like the clitoris, around the vaginal entrance, or one labia. The rules are the same here, it can be provoked by touch, or without and occurring insidiously, or a mixture.

Localized Provoked Vestibulodynia: The vestibule is the area between the two labia minora. So basically the skin around the entrance to the vagina is painful with touch or after touch, sexual or not.

This tends to be a diagnosis that gets brushed under the rug, likely due to it’s elusive symptoms and no standardized treatment. Doctor’s often don’t know what to do about it and most don’t know that pelvic health physical therapy exists as a outlet for treatment.

Much like vaginismus, when I see someone with vulvodynia for the first time, I take a very thorough and personal history. This can get awkward for some peeps, but you are seeing me about vagina probs, so I gotta ask! You get it. Then I carefully determine the need for an internal or a modified exam – whenever the client feels comfortable with it and is necessary to direct treatment.

Let me just expand on the exam for a minute. My first and foremost concern is to keep it pain-free, pain-free and pain-free. Also, pain-free. I do not use a speculum, stirrups, or headlamp… I first start with observation of the tissue externally, then palpate (touch) gently and perform a couple of tests to help me narrow down symptoms. Then, if the client is ok with an internal exam, I only use my pointer finger (it’s small, I might add) to assess muscle mobility, tenderness and control at the entrance of the vagina and then again a little further in (only up to my second knuckle) at the deepest layer of pelvic floor musculature (levator ani). I will check for prolapses and any incontinence issues at that time, as well. However, at anytime the client feels uncomfortable or wants to cease the exam, it’s done. And I make sure they know they are in control of that whole process!

So on to treatment. There are likely some behavioral and environmental barriers here contributing to the painful vagina, so I normally address those first, and then review and modify throughout the treatment plan as necessary.

Those barriers could be:

  • Tight clothing
  • Irritating underwear
  • Vaginal hygiene problems (washing with soap)
  • Work environment (are you sitting a lot, sweating a lot)
  • Modes of exercise (do you ride a bike, swim, etc)
  • Vagina pube-style
  • Medications
  • Diet
  • Psychological barriers relating to your vagina and/or sex
  • The list goes on…

Once we have established those barriers and found solutions, that helps to determine the next step in treatment. We may work on improving the mobility of the pelvic floor muscles to decrease the pain through use of dilators, soft tissue massage, stretches for hip/leg/back muscles. Then, implement techniques to improve control of the pelvic floor, like biofeedback. We will discuss and practice treatment techniques for home and for long term management of symptoms. My goal is to always treat someone until their symptoms are managed and they are able to return to a pain-free life, pain-free sex, pain-free exercise, pain-free tampon use, etc. If the symptoms are not improving after some time with varying types of PT intervention, I will often refer back to their doctor or to another specialist to see if we can work as a team to solve the issue.

If you have symptoms of vulvodynia, please please PLEASE ask your doc about it. You deserve to have a happy vagina!(#happyvaginahappylife)

I have had so many of you reach out to me already and it makes me so happy you are looking for solutions. If any of you have a vulvodynia success story, I would love to hear it and also share it with this community! We could all benefit from the encouragement found in a success story. Email me at: 




Photo sources:
Feature photo: Minerva Freire/
Khloe Kardash pic
Ben Stiller pic
Cycling babe
Soapy soap pic


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