Vulvodynia is a painful condition affecting roughly 16% of all women in the US. It involves a burning sensation surrounding the region of the vulva — including the opening of the vagina, the inner and outer lips, and the clitoris.
“What we do know is that vulvodynia is a problem with the sensory nerves,” Tania Adib of The Medical Chambers Kensington tells Women’s Health Magazine. “They are oversensitive and send pain signals back to the brain when they shouldn’t. But why they start doing this, we don’t know.”
Dr. Blatman disagrees. In actuality, we do not in any way KNOW that vulvodynia is a problem with sensory nerves. One of the reasons so many people continue to suffer with unrelenting pelvic pain is because it does not come from the nerves that everyone thinks need to be treated. Pelvic pain comes from fascia injury to the thighs, pelvis, gluteals, and abdomen. Like most other enigmatic chronic pain, unkink and restore integrity of fascia from injuries of a lifetime, and the pain goes away.
Every treatment goal of vulvodynia is the same: Make the pain stop. And that usually involves experimenting with a variety of different methods. Here are a few you can try.
Biofeedback therapy involves taking electrical sensors to certain areas of the body in order to gain information about your response to pain. In treating vulvodynia, this therapy helps relax the pelvic muscles. Tightening these muscles can be a source of the pain because the fascia kinks also become tighter.
At our Cincinnati health and wellness clinic, we can also do a therapy known as TempSure Envi. This involves using radiofrequency to gently heat up the region surrounding the vulva and encouraging the production of collagen, which can result in supple, more dense and seemingly younger skin surrounding the vagina. It can revitalize intimate wellness, rejuvenate fascia, and ease the pain associated with vulvodynia.
There are a number of medications that can help treat the pain associated with vulvodynia. Amitriptyline, for example, is an oral antidepressant that can also help treat vulvodynia when used at a very lower dosage. It effectively reduces the sensitivity of the nerve endings and prevents pain in the vulva. Gabapentin — an anticonvulsant usually prescribed for epilepsy — can also be effective at treating the pain. (Dr. B thinks this is because it makes nerves and memory less functional, and the nerve endings within the kinks of injured fascia get quieter so you can no longer “feel” the injury.) Lidocaine is an anesthetic gel that can be applied to the vulva throughout the day to decrease pain.
Nerve Blocking Agents
There are a number of nerves that carry pain signals from your vagina to your spinal cord. Your health and wellness doctor can inject an anesthetic into those nerves to alleviate the pain and serve as a nerve block. If other treatments fail to work, this can provide either short term or long term relief. These treatments usually provide only short term relief unless they inadvertently unkink part of the ‘pain causing’ fascia.
Trigger Point Injection Therapy
This is a form of needle therapy that targets a trigger point — an area of the body where muscle and fascia are kinked into a knot. These knots are located within the densest and most tender part of the ropey band within the muscle. This kink puts pressure on nerve endings within the muscle and fascia (myofascia) and these nerve endings initiate the signal we interpret as pain. And from this source, our nervous system cannot distinguish numbness, burning, tinging, aching, cramping, stabbing, knifelike, itch, tickle, and even sexual arousal comes from fascia nerves. Massage can also help provide relief to the vagina by un-kinking fascia and increasing blood flow.
Acupuncture is an alternative therapy that has also shown to be effective at treating vulvodynia. Needles carefully applied to certain regions of the body can help improve blood flow and circulation, relieving pain. More importantly, these needles can cause a release of the fascia kinks that directly cause most of the pain.
Adjustment in Undergarments
We recommend wearing loose fitting underwear — nothing tight. Avoid wearing tight clothing, especially around the crotch. Switch your feminine sanitary care to a non-perfumed organic alternative. Avoid scented shower gels.
Pelvic Floor Therapy
Pelvic floor therapy is a method of working with the muscles and fascia of your pelvic floor — the muscles that support your uterus, bladder, prostate, and bowels. When this fascia tightens, discomfort increases. Physical therapy such as kegel exercises can help strengthen these muscles and provide pain relief. Ultimately, pain relief comes from unkinking and healing the fascia injuries of a lifetime, and most of these involve thighs, pelvis, and abdomen.
Surgery is usually used as a last resort. In rare cases of vulvodynia, the issue is an area of the vulva extremely sensitive to pain. This can be surgically removed. Dr. Blatman strongly urges reconsideration. Pelvic pain should not be attributed to nerve (pudendal neuralgia) or blood vessel until there is no tenderness in the muscles and fascia of the thighs, pelvis, buttocks and abdomen.