Have you got Vulvodynia or Vaginismus?
Vaginismus is basically just tight pelvic floor muscles, which makes getting a tampon in or having penetrative sex painful or difficult. Your pelvic floor can be generally tight all the time (think about how tight your hamstrings get when you’ve been sat driving all day, the day after a run or you’ve never stretched them until that yoga class and down-dog was an experience..). Your pelvic floor muscles can also go into spasm when thinking about or having anything penetrate the vagina (like when your calf goes into cramp in the night). Both aren’t pleasant, and both are totally treatable. Treatment is exactly what you’d do with any other muscle – learn to relax them and give them a gentle (and regular) stretch. It shouldn’t hurt.
Vulvodynia is a pain in and on the vulva, where tests have shown there to be nothing ‘wrong’. I like to think of vulvodynia in these terms: your body has decided that your vulva is under attack and so has become hypersensitised (Defcon 20!) to respond to that attack, and then forgotten to chill out again. So now instead of fighting off an infection, thrush, or whatever it thinks may have prompted this response, it’s getting seriously concerned when you sit down, or wear new underwear, or get sweaty, or try to have some intimacy. Everything’s a bit on edge. Physio treatment is all about resetting your vulva back to neutral – not under attack. And it shouldn’t hurt.
There are so many simple health concerns that on a google search sound like Vulvodynia or Vaginismus, from repeat thrush or bacterial vaginosis infections, itchiness caused by vaginal dryness during perimenopause and menopause, to menstrual pain. It’s really worth seeing your GP as your first port of call who can do some simple tests to rule things out. A skilled clinician will then be able to point you in the right direction, which should involve Pelvic Health Physiotherapy if all tests are negative.
Our top tips for Vulvodynia and Vaginismus:
See a GP and get tests done to see if you have an infection. This is really easy and quick to treat.
Talk to your GP about treatments for repeat infections if this is happening a lot.
If this hasn’t helped then talk to your GP about vaginal dryness (officially “Genitourinary symptoms of the menopause” or “GSM”, what we used to call Atrophic Vaginitis) and get them to give you some vaginal lubricant specifically designed to help hydrate down below. My favourite is Yes Vaginal Moisturiser (click to visit).
Get a consultation with a Gynaecologist specialising in skin (dermal) conditions.
Have a pelvic floor assessment with a qualified pelvic health physiotherapist as many conditions are to do with the greater health of your internal and external pelvic area. We can sort this!
Look at the mind/body connection – pain is predictive (this doesn’t mean you’re making it up!) If you’ve avoided something because it always feels painful for a long period then a physio can help you to break it down into smaller steps to make it not hurt.
Physio doesn’t hurt. If you’re in pain and seeking treatment the treatment provided to you should never make your pain worse. That’s worth repeating. If it does you need to tell your therapist so they can adjust their approach in response – they’re learning about your body as well.
Remember the body is constantly changing and adjusting, and recovery from Vaginismus and Vulvodynia can happen.
Looking for a Physiotherapist? You can search for someone in your area here on the Squeezy App webpage.
The Vulval Pain Society may also be worth a visit.
One thing to note, however, is that you won’t see much mention of Physiotherapy treatment. (Yet!) That’s just a hangover of the medical profession in general – physiotherapy may now be recognised in national guidance as a fundamental first line treatment for many pelvic health conditions but change filters down slowly. Because vulval pain can be caused by many different reasons, pelvic health physiotherapy encompassing optimising All your pelvic organ functions (bladder, bowel, vagina, muscles) as well as alleviating pain, can be crucial to changing your symptoms. It’s always best to get a solid medical team around you – you need your doctor or GP, gynaecologist with specialising knowledge of pain and pharmacist as well as your physio supporting you.
If you’re struggling with Pelvic Pain in general have a look at this video.