The terms dyspareunia, vaginismus, vulvodynia, provoked vestibulodynia and pudendal neuralgia all have one thing in common - pain. Specifically, pain around the vulvar, which is the external genital region of the female including the labia majora, labia minora, clitoris, vaginal opening and urethral opening. At our three Sydney Physiotherapy Clinics in the lower north shore (Cammeray), eastern suburbs (Bondi Junction) and Sutherland Shire (Woolooware) our women's health physios  see many patients walking through our doors that have been diagnosed with these conditions.  

 

If we breakdown it down, dyspareunia put simply means pain with penetrative sexual intercourse. Almost all of the other conditions (vaginismus, vulvodynia, provoked vestibulodynia ) can be a cause dyspareunia  (painful sex).  

 

Vaginismus is a spasm of the pelvic floor muscles and is typically diagnosed once disease related causes of pain are ruled out. You can understand that  if the pelvic floor muscles are involuntary in spasm or contraction, this will reduce the size of the vaginal opening making penetrative intercourse painful (dyspareunia).  Dyspareunia and vaginismus can also be referred to as “genitopelvic pain penetration disorder”. 

 

Vulvodynia is defined as vulvar discomfort.  Put simply, it is pain of the vulvar unexplained by vulvar or vaginal infections, skin disease or neurological conditions. Is often described as burning pain.  Vulvodynia is not necessarily initiated by touch or pressure to the vulvar it can be present at any time . On the other hand, provoked vestibulodynia is diagnosed when pain IS elicited as touch or pressure is applied to the vulvar/vestibule ( the inner part of the labia minora). With provoked vestibulodynia, it is common to have point tenderness and pain with vaginal entry.  

 

Neuralgia means pain in the distribution of a nerve or nerves and is produced by irritation to the nerve itself. Patients will often report pain, shocking, burning, tingling and numbness that often follow the path of a nerve. The pudendal nerve supplies the muscles of the superficial pelvic floor but also has sensory nerves that supply the inner part of the vulvar including the clitoris and anus. Irritation to the pudendal nerve can happen anywhere along its pathway. It does pass through the pelvic floor muscles where it can be getting compressed and irritated. Often performing release work to the pelvic floor muscles from your women’s health physiotherapist can assist with pudendal neuralgia. 

 

There are many physiotherapy treatment options for the conditions above. Be sure to see your womens health physio in the Shire (Woolooware), Bondi Junction and Cammeray for help!