A multifactorial pathology, vulvodinia requires intervention on multiple fronts. We talked about the basic role of physiotherapy with Dr. Arianna Bortolami, a physiotherapist and sexology consultant in Padua
Who are the patients who come to your practice?
They are women who are in a lot of pain, unfortunately from multiple points of view: they have pain in the genital area, they often have difficulty or inability to have sexual intercourse, they may have alterations in urinary and bowel function, they have a hard time sitting, and their work activity can be affected by this. They also have a very impaired social life, and sleep and nutrition are also often impaired by symptoms
Why then physical therapy?
Because many patients have muscles in the genital area, which are called the pelvic floor, that are stiff, contracted, with poor range of motion
What does this entail?
It negatively affects the functions these muscles are responsible for, which range from urinary to fecal to sexual. In fact, pelvic floor muscles surround the urethra (the channel that connects the bladder with the outside), the anal and vaginal canal. In this way they contribute to bladder and rectal filling and emptying. They are also involved in the act of penetration thus contributing to sexual pleasure
Where, then, does pain arise from?
In vulvodinia, pain is due to an alteration of the circuits of sensitivity, and for this reason it can be felt locally or generalized in the genito-urinary-anal area. In addition, sometimes as a consequence, sometimes as a cause, the pelvic floor muscles, like any other muscle in our body, become contracted causing, in addition to the alterations described above, pain. If they are contracted penetration becomes painful, if not impossible. To pain is added pain, in a vicious circle that leads the muscles to contract even more with an accentuation of physical and emotional suffering
But why are the pelvic floor muscles so contracted?
Some studies have pointed to the fact that there are women who are genetically predisposed to have overactivity of this muscle. Some women become aware of it the moment they fail to insert an internal tampon; others become aware of it when they begin to have intercourse. In other cases, however, the overactivity of the pelvic muscles may be brought about by the onset of recurrent infections that change the circuits of sensation resulting in excessive contraction and causing pain
How can physical therapy be helpful?
Like all muscles, those in the pelvic area can be rehabilitated so as to restore the functions they preside over, including sexual function, with the ultimate goal of eliminating pain and allowing the resumption of a normal living condition
How then is it done?
Physical therapy intervenes on the pathology with a variety of techniques and tools. It starts withtherapeutic exercise, which is essential first and foremost for women to become aware of muscles of which they are often completely unaware. Once you have learned to “feel” the part, you can use a series of exercises aimed at resolving the overactivity of the pelvic muscles. You also intervene with breathing techniques that help the pelvic floor relax. Manual techniques are used, with which stretching is performed in the vaginal canal, and with instrumental techniques such as antalgic electrical stimulation (TENS), or radiofrequency, which allows anti-inflammatory substances to be delivered to the site. Biofeedback, an instrument that is able to record the muscle activity of the pelvic floor and which is particularly useful, especially in the initial phase of rehabilitation therapy, can be used to facilitate awareness of the part. During the rehabilitative course with physiotherapy, the use of vaginal dilators may be recommended, which are useful for breaking a well-established motor pattern that leads to contraction of the pelvic muscles at the time of penetration, accentuating the pain and thus allowing the woman to make penetration without pain. It is also important to associate behavioral treatment, which consists of suggesting the adoption of lifestyle habits that can lead to an improvement in the pathological picture
Does every woman follow the same course?
Absolutely not; in fact, it should always be kept in mind that when talking about vulvodinia, as mentioned before but worth repeating, every woman is a world apart. The goals to be achieved with physiotherapy are common: first and foremost, to take away the pain, through becoming aware of the pelvic floor, decreasing tone and learning a series of automatisms that allow for a reduction in pain symptoms. How one achieves these goals, what and how many strategies one needs to implement in physiotherapy are all personal issues. As is the time it takes to regain a normal living condition, also depending on the starting situation. As is the case with any other rehabilitation pathway, even with pelvic floor it must be kept in mind that it still takes time for the brain to learn or regain mental skills that it never had or forgot. In any case within two to three months the first improvements can already be seen.
