Pain with penetration: vestibulodynia

The term vestibulodynia refers to pain in the vestibule, which is the space between the entrance to the vagina and the labia minora. People with vestibulodynia often report significant pain during penetration (dyspareunia), sometimes so severe that the pain prevents penetration altogether. Also, some women will avoid using tampons because of the discomfort during insertion and withdrawal.

Signs and symptoms:

• severe burning sensation when the area before the vagina is palpated or if there is insertion (finger, penis, tampon, etc.)

• pain that can be caused by sitting for a long time

• no visible redness or discharge

• no bacteria or yeast involved

Diagnostic:

To find out if you have vestibulodynia, the health care professional will use a mounted rod to apply a small amount of pressure on the vestibule. When this pressure causes pain, the test is considered positive.

The link below shows you how each step of this test is performed.

https://www.instagram.com/p/CcpwaUEP3a5/

Why is this happening?

Many factors can influence the onset of vestibulodynia. Here are a few examples:

following a pregnancy

following a major psychological stress

significant abdominal tension

chronic constipation

stiffness in the thoracic and lumbar spine

Although vestibulodynia is multifactorial, the result is usually irritation of the nerve endings to the vestibule. The irritation of these endings is the reason why the pain is mainly of the burning type.

Treatment:

In order to alleviate this condition, we must first find the factors that can potentially irritate the nerve endings. The physiotherapist will therefore evaluate the mobility of the abdomen, the contractions of the pelvic floor and the general tone, but will also evaluate the mobility of the back and the pelvis. You will also be asked questions about your lifestyle and your elimination habits (stool and urine).

Once the predisposing factors are known, it will be a matter of finding ways to reduce the impact of each of them, or even eliminate them. Here are some examples of techniques that the physiotherapist can use to treat vestibulodynia:

• myofascial release

• muscle release techniques (pinch and roll, massage)

• PNF (contracting opposing muscles to achieve release)

• orthopedic manual therapy (mainly for thoracolumbar stiffness)

• breathing exercises

• If necessary, we can even suggest a psychological or sexological follow-up

Why live with pain?

One thing is certain, having pain during penetration is not normal. This pain can greatly affect a couple's relationship and cause a lot of stress. Don't hesitate to discuss it with a health professional!

Written by: Andrée-Anne Lorrain, physiotherapist and registered nurse