What is vulvodynia?
Vulvodynia refers to vulvar discomfort or pain of at least 3 months’ duration, without a clear identifiable cause for the pain. Approximately 16% of women experience this type of vulvar discomfort and or vulvar pain at some time in their life. Vulvodynia may be either generalized to the entire vulva (termed generalized vulvodynia) or localized to specific areas of the vulva (e.g., the clitoris – termed clitorodynia; the vulvar vestibule – termed vestibulodynia). Further, the pain or discomfort may be either provoked (i.e., occurring only when the area is touched such as during sexual activities or gynaecological examinations) or unprovoked.
What are the symptoms?
Women experience uncomfortable sensations such as burning, stinging, irritation, stabbing, or rawness. The discomfort may be mild or severe. Some women find the symptoms very distracting and report that the symptoms interfere with daily living activities (wearing clothes, sitting, or walking) and/or sexual activities.
How is vulvodynia diagnosed?
The diagnosis of vulvodynia is based primarily upon a women’s history and a thorough clinical exam of the vulva and vagina. No special investigations and or tests are usually needed.
How do you treat vulvodynia?
There are many different therapies and treatments available for women suffering from vulvodynia including medical, behavioral, and surgical treatments. Women will often need to try several different treatments before experiencing significant pain relief. The longer a woman has been experiencing pain, the more likely that she will benefit from a multidisciplinary approach to treating her pain. Our current multidisciplinary program is offered 2 days per week and open to women between the ages of 19-45 years of age.
National Vulvodynia Association has a Self Help Guide which you can access here. Other resources can be found here.
Watch our online Education Forum for an overview of the treatment approaches offered in the MVP.
Your Journey through the MVP
What to expect from the assessment appointment?
Women who experience chronic vulvar pain will be initially assessed by a health care provider in the Centre for Vulvar Health. The assessment includes a discussion about your health concerns and your past health history. If appropriate a clinical examination will also be performed. At the end of the assessment appointment you and the health care provider may have a clearer idea as to what is causing your pain. Sometimes more investigations are needed to clarify the cause of your pain. Once the factors contributing to your pain are identified the health care provider may recommend participation in our multidisciplinary vulvodynia program. However this intense program is not appropriate for all women who experience chronic pain. Some women prefer to pursue treatment with their own health care providers and or in their own communities (seeking help from psychologists and or physiotherapists) and other women would benefit from a more individualized treatment plan. Your health care provider will discuss the best options for treatment with you.
What to expect from participating in the treatment program?
Educational interventions: The MVP offers several educational group seminars for women. By providing women, and their partners, with information about this pain condition, we aim to decrease the anxiety and fear that are often associated with vulvar pain.
Pelvic Floor Physiotherapy: Each patient enrolled in the MVP will have the opportunity to have one or more individual and/or group sessions with one of our pelvic floor physiotherapists.
Group Psychoeducational Skills Training Sessions: these facilitated small group sessions aim to help women find effective ways to address their pain and improve their sexual and emotional well-being.
Psychoeducation involves a combination of education infused with psychological therapy aimed at exploring thoughts, feelings, and behaviours. Sessions are facilitated by a Registered Psychologist, and on occasion, facilitated by an upper-level Clinical Psychology intern/trainee.
In the MVP program, the goals of these sessions are:
(1) To understand and therefore better manage pain from touch or pressure to the vagina due to vestibulodynia and/or pelvic muscle tension from a psychological perspective;
(2) To understand vestibulodynia/pelvic muscle tension as a pain disorder that is influenced by, amongst other things, thoughts, feelings, and behaviours, including those that are in response to both internal and external stress;
(3) To be able to understand one’s reaction to stress and pain, so as to better cope with pain;
(4) To capitalize on the therapeutic benefit of group exchange, modeling, and support;
(5) to emphasize that these sessions are quite possibly the first step in the process/journey toward managing a waxing and waning condition. Most importantly, in this group you will be applying psychological skills learned in this and the educational seminar to actual situations in which you are anticipating or experiencing pain.
Throughout this psychoeducational group, the goal is to provide a safe and respectful environment for learning and psychological growth. You will be provided with handouts that will form the basis of homework exercises to be completed between sessions. There will be daily homework assignments between sessions. Commitment to attending all three sessions and complying with as much of the homework as possible is a requirement to be accepted into the MV Program. It is not a requirement that women disclose any personal information they do not wish to share during the group.
Specific skills that you will acquire:
- Learning about mindfulness, and how mindfulness can help with one’s reaction to pain and stress
- Induction of the relaxation response and practice of mindfulness with the Body Scan
- Learning how to identify maladaptive or biased thoughts
- Learning about the components of the female sexual response cycle, and beginning to recognize the variables that may help or hinder your personal sexual response
- Understanding how the anticipation of pain influences the rest of the sexual response cycle
- Understanding how a psychological approach can be used to complement other modalities of treatment
Final Treatment Planning Appointment: Women take part in either an individual or group treatment planning appointment after all prescribed components of the program have been completed. At this appointment, women have the opportunity to discuss what they have learned in the program, what treatments they feel will be of the most benefit going forward, and the next steps/plans to pursuing these treatments. A summary of this discussion is then forwarded to the physician who will be resuming the ongoing care of the women.
Recovery with Support from your Primary Health Care Provider: The MVP works within a “shared care” model – Women are referred to the program by a health care provider who has agreed to continue with providing health care to the woman with vulvodynia after she has finished the formal components of the MVP. All health care providers are sent a detailed plan for recovery from the MVP. Women are encouraged to meet with their providers soon after they finish the MVP to review their progress and make plans for ongoing care in the community.