The term sexual pain has been replaced in the literature by vaginismus and dyspareunia, which are characterised by increased pelvic floor muscle tension. Women who experience these condition have limited ability to function sexually and often struggle to find a diagnosis, seeing various health care professionals along the way. Understandably these conditions, which often overlap, are very upsetting and frustrating for women. Physiotherapy treatment aims to increase pelvic floor muscle awareness, improve muscle relaxation, normalise muscle tone, increase elasticity at the vaginal opening, desensitise painful areas and decrease fear of vaginal penetration.
Dyspareunia is characterised by difficulty with vaginal penetration, with pain the main diagnostic criteria. Vulvodynia is one of the leading causes of dyspareunia.
The vulva is the external part of the female genitalia. And protects the sexual organs, urinary opening, vestibule and vagina. Vulvodynia is defined as pain anywhere in and around the vulva. Symptoms include burning, itching, stinging or sharp pain. It may occur at any age but is common in women of child bearing years, and is estimated that 16% of women will experience it in their lifetime. Symptoms can vary in location (eg. Vestibulodynia, clitorodynia). Pain may be constant or may be caused by light touch (e.g. tight clothing rubbing off the area), sex, tampon use or pressure on the area (eg. Cycling). Vulvodynia is thought to have no known cause, and much debate exists as to whether it is caused by injury, inflammation, or irritation/hypersensitivity of the nerve fibres in the vulval skin (shown in the picture below ).
Vaginismus is best described by those who suffer it, as a “panic attack of the vagina”. It is defined as an involuntary tightening/spasm of the muscles at the entrance to the vagina. Typically women with vaginismus experience pain in anticipation of/or during sex, medical examination or tampon use. Phobic avoidance of painful stimuli is sometimes noted in vaginismus sufferers. Symptoms are similar to those experienced by vulvodynia sufferers.
These conditions have an enormous impact on women’s psychosexual health and quality of life, as well as on their partners. The goal of physiotherapy is to assist women in managing their condition and liaising with other health care professionals involved in their care. Physiotherapy treatment may include, trigger point release, connective tissue massage, stretching, dry needling, pelvic floor awareness and retraining, and advice and education regarding pain management.