I Have Vulvodynia, How Can Therapy Help Me?

Dealing with the pain and life-impact of vulvodynia can feel overwhelming. This is true of most chronic pain conditions, but vulvodynia is especially hard because vulvar and vaginal pain is tricky to talk about with others and there is less information about it than we would like. What we do know is that psychotherapy for vulvodynia can help.

What is Vulvodynia?

Vulvodynia is pain on the outer part of the female genitals, including the vaginal opening. This area is called the vulva. Symptoms of vulvodynia can vary among individuals but commonly include a feeling of burning, stinging, soreness, or stabbing pain in the vulvar area. The pain may be constant or occur intermittently, and it can be triggered or worsened by activities such as sitting for long periods of time, or sexual intercourse. In many cases, it is difficult to pinpoint precisely what initially caused the pain to start.

Vulvodynia is typically chronic (lasting 6 weeks or more) and is considered to be a multifactorial (kept going by many factors) condition. These factors often include nerve damage or irritation, central sensitization, muscle spasms, inflammation, and psychological factors (like anxiety).

How is Vulvodynia Diagnosed?

Vulvodynia is most often diagnosed when other pain-causing conditions are “ruled out” (diagnosed and properly treated). Such "rule-out" conditions include dermatological (skin) problems or active skin infections.

An OBGYN doctor with a solid background in pelvic pain conditions should conduct a thorough medical history review, perform a pelvic examination with a q-tip test, and in most cases lab tests as well. This process often takes multiple visits and can be pretty nerve wracking.

How is Vulvodynia Treated?

Often, not as well as it could be.

Most people with symptoms end up going from doctor to doctor looking for help and answers. The process of getting diagnosed and treated can be pretty stressful.

The optimal treatment of vulvodynia is multimodal (made up of many clinical disciplines and modes of treatment, not just one thing) since the condition is multifactorial.

Ideally, treatment is a collaboration between psychotherapy, pelvic physical therapy (PT), and OBGYN and involves a personalized combination of helpful things from each discipline. These include medications, exercises, and cognitive-behavioral adjustments.

How Specifically Can Psychotherapy Help Reduce Pain?

Specifically, psychotherapy can help address contributing and perpetuating factors such as fear-based thinking, stress, and embodied [medical] trauma. Psychotherapy has a positive, pain-shrinking impact on the central (brain & spinal cord) and peripheral nervous systems. In therapy we identify sources of stress and anxiety that amplify pain as well as pain-perpetuating behaviors. Then we use science-backed techniques to decrease pain and make other medical treatments more effective.

Importantly - using psychotherapy to treat your pain does not mean that it’s “in your head” or that you caused it or that it isn’t “real.” It does mean that the mind-body connection is real and we use it as a tool in healing your very very real physical pain.

Pelvic physical therapy providers diagnose and treat pelvic floor problems that contribute-to and perpetuate vulvar pain. OBGYN providers are able to prescribe topical medicines to improve skin integrity and oral medicines to mitigate the impact of neurological changes.

How multimodal methods are combined and sequenced needs to be tailored to you and no one thing is likely to be the silver bullet. But I know deep down we really really want it to be, and that’s hard.

Okay, But Isn’t There One Best Solution To My Pain?

Perhaps one approach will have the most impact, but we don’t know what that will be for you. That’s why we advocate for shrinking pain from many angles.

The highest quality of scientific and clinical evidence is in support of psychotherapy and pelvic physical therapy approaches for the treatment of vulvodynia. This might be surprising, because we reflexively think of pain as something “medical” and requiring a mostly or primarily medical approach. Research shows that this is less true for chronic pain, like vulvodynia.

If you would like to learn more about psychotherapy for vulvodynia, check out my Healing Pelvic Pain Workshop. or get in touch for a free consultation. I'm a pain psychologist and I provide online therapy in California and New York.

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