Download Techniques to help with Vulvodynia

Techniques to help with
Vulvodynia
Information for patients
Dermatology Department
This leaflet is to give you information about Vulvodynia.
What is vulvodynia?
This is a term used to describe the condition of chronic vulval pain. Women with vulvodynia
often experience the sensation of vulval burning or soreness in the absence of any obvious
skin condition or infection. The pain can affect the whole vulva or one specific area, such as
the introitus (entrance to the vagina, see figure 1).
This condition can arise as a consequence of irritation or hypersensitivity of the nerve fibres in
the vulval skin.
Abnormal nerve fibres can give a sensation of pain even when the affected area is not
touched. These nerve fibres may have a very low threshold for signalling pain, or other
sensations (such as hot, cold, stretch or pressure) may be felt as pain. A number of
techniques can be used to help de-sensitise the vulval area but the first step is to learn how to
relax the pelvic floor.
Figure 1 – The vulva
Pelvic Floor Relaxation
The pelvic floor is formed by a group of muscles and supporting tissue that act as a
supporting floor to the pelvis, from the pubic bone at the front to the base of the spine and the
coccyx (tail bone) at the back. The pelvic floor supports the bladder, the cervix and uterus
(womb) and the bowel.
Exercising the muscles of the pelvic floor can help strengthen the pelvic floor, and will also
help you learn how to relax these muscles when you need to.
How to exercise the pelvic floor muscles:
1. Go to a quiet room where you will not be distracted or disturbed.
2. Sit comfortably on a firm chair so that your feet are resting on the floor and slightly apart,
or lie back on the bed with a pillow supporting your legs under your knees.
3. Place one hand flat over your tummy.
4. Concentrate on the area around your vagina and try to tighten these muscles. Imagine
that you are trying to stop yourself from passing urine and wind.
5. Try to ‘squeeze and lift’ the muscles around the vagina and back passage. Try not to pull
the buttocks o thigh muscles at the same time.
6. It is important not to hold your breath, and to continue to breathe gently.
7. Try to squeeze the muscles for as long as possible (up to 10 seconds).
8. Allow the muscles to fully relax; this may take around 4 seconds.
9. Repeat the exercise.
You should practice these exercises on a daily basis, when you have time to do so without
being disturbed. Avoid rushing the exercises. Be aware it may take 6-8 weeks before you
notice an improvement.
You should start with concentrating on tightening your pelvic floor. Once you can do this, you
should try to relax your pelvic floor as you breathe out.
If you are unsure on when you are contracting your pelvic floor muscles, you could try
inserting a finger into the vagina to check the strength of the squeeze as you tighten the
pelvic floor muscles.
If you find that you are unable to tighten your pelvic floor, you may need to be referred to a
physiotherapist for assistance or biofeedback (learning which muscles you are exercising) to
help you with strengthening and relaxation techniques.
If you are overweight try to reduce your weight and have a healthy diet, as this will put less
pressure on your pelvic floor muscles.
Whole body relaxation
It may be helpful to learn whole body relaxation techniques to assist with relaxation of pelvic
floor muscles. This will also help relieve the muscle tension in other parts of the body. It may
be useful to listen to a relaxation tape to help you.
Desensitisation techniques
A helpful technique once you are able to relax your pelvic floor is to desensitise the overactive
nerve endings or reflexes which may be contributing to your vulval pain.
As a consequence of vulval pain, your normal reflexes or guarding responses can be overexaggerated. Many women benefit from ‘un-learning’ this protective response. The following
techniques need to be introduced gradually but will progress over time.
1. Use of vaginal trainers
The approach is similar to learning pelvic floor relaxation in that you need to choose a
convenient time and place where you will not be distracted or disturbed. You will need about
20 minutes a day to perform this technique.
You should lie on the bed with a pillow to support your legs under your knees and with a room
temperature comfortable to be undressed from the waist downwards with a light cover on top.
It is important to start with the smallest vaginal trainer or use a finger. You should use a
lubricating jelly to avoid any friction. The trainer should be inserted into the vagina in a
slightly backwards direction to stretch the opening to the vagina. You should push the trainer
in as far as comfortable and initially leave it to rest there for 10 minutes.
Once you feel comfortable in using the trainer, you should attempt to remove and re-insert the
trainer so that the vaginal and vulval tissues are able to cope with stretching of the skin and
tissues.
Once you are comfortable with one size of trainer you should move up on to the next size of
trainer. This may take days or even weeks, but you should not rush to move on to the next
size.
2. Perineal massage
The perineum is the area between the vagina and the anus (back passage). Perineal
massage is another useful technique for desensitising the vulval skin, allowing the nerve
endings in this area to get used to the sensation of pressure or vibration again.
You should use a lubricating emollient or gel to avoid undue friction. Use your thumb or the
pad of the index and middle fingers to gently massage over the perineum. If your pain is
localised to the entrance of the vagina then this is the area to be massaged. You should
initially attempt very light pressure for a minute or two, but you should aim to increase the
amount of time massaging and the amount of pressure applied.
It can be useful to massage the perineum and the introitus (entrance to the vagina) using a
small hand held vibrator or perineal massager.
Transcutaneous electrical nerve stimulation (TENS)
TENS is widely used to help with pain relief in labour, chronic back pain and other chronic
pain conditions. It works by helping to block the pain signal being sent up to the brain. This
can be useful for some women in vulval pain and needs to be used once or twice a week over
6 – 8 weeks. The nerve stimulating equipment can be applied to the lower back where the
nerves supplying the vulval area exit from the lower spine, or by a probe that is inserted into
the vagina.
Pelvic floor muscle trigger points
Vulval pain can arise from trigger points in the pelvic floor muscles. These are areas of tight
or tense muscle. You would need to be assessed to identify if you have such trigger points
and to learn appropriate techniques to help release this tightness. This is similar to the
massage and stretch techniques used by physiotherapists, for example, for low back pain or
joint or muscle injuries.
Psychological help
With any chronic vulval pain syndrome, regardless of the cause, there is likely to be a
psychological/emotional component. This may or may not also make sex difficult or painful.
For further exploration of sexual problems in relation to vulval pain, brief psychoanalytical
therapy can help. If you would like to consider this further you may ask to be referred to the
Psychosexual Medicine Service.
Further information
Useful websites:
Vulval Pain Society – www.vulvalpainsociety.org
The International Society for the Study of Vulvovaginal Disease – www.issvd.org
Perineal massagers - www.emotionalbliss.co.uk
www.bbc.co.uk/relationships/
Contact telephone numbers:
Vulval Skin Clinic Secretary – Telephone: 01382 632821
This leaflet has been developed with the permission of Honorary Consultant in Gynaecology,
Aberdeen Royal Infirmary
Revised by Consultant Dermatologist
Reviewed: 07/2016 Review: 07/2018 LN0483