Guest Blog: 6 Steps to Take If You Have Vulvodynia
PainDownThere.com and the Pain 'Down There' video resource guides are a great place to start in the foundations of healing chronic sexual, genital, and pelvic pain. But it is not intended as a replacement for individualized care. We are happy to recommend The Integrative Women's Health Institute Virtual Clinic as part of your multidisciplinary healing team. They are now accepting new patients.
Author: Jessica Drummond, MPT, CCN, CHC
Founder and CEO of the
Integrative Women's Health Institute
Vulvodynia affects over 14 million women in the US alone.
What is vulvodynia? Vulvodynia is the fancy medical term for vulvar pain, or pain specifically in the vulvar vestibule (a small bit of tissue at the back of the vaginal opening) that can be provoked or generalized.
If your vulvodynia is provoked, then it only bothers you when the tissue is irritated, during sex, when wiping after using the bathroom, when wearing tight pants, sitting, etc. If it's generalized, the pain can surface at any time.
As with any chronic pain condition, your body has the wisdom that it needs to heal. It is your job, together with your healthcare team, to set the stage to make it easier for your body to heal. All chronic pain conditions have body, mind, and spirit components. My clients usually find it easier to start with creating optimal conditions in the body.
Here are the 6 steps that we work through to resolve vulvodynia from the root cause for each unique client.
1. Structural - There are muscles just inside of your vulva that support your vagina, bladder, rectum and are an integral part of your pelvic structure. Just like any other muscles in your body, these can be tight, weak, and/ or in spasm. Working with a highly skilled pelvic floor physical therapist can help you to find any issue with your muscles or other soft tissues and using self-massage or other manual therapy techniques - sometimes combined with energy work, visualizations, affirmations, breath work, and/or exercises to relax and strengthen those tissues.
2. Nervous System Quieting - Many people with chronic pain live in a state of "fight or flight." If your nervous system is more sensitive to pain or discomfort due to lack of sleep, excessive intake of inflammatory foods, emotional stressors (often related to job, relationship or caregiving stress), chronic infections, excessive environmental toxin exposure, or pain "cross talk" from your reproductive organs, bladder or colon strategies that help to calm the nervous system allow your body to become less sensitive to stimulation that is currently causing you pain.
We work with each client to develop a unique nervous system quieting program that is tailored to her needs. For most of my clients sleep strategies are essential, mindfulness, yoga, and/ or breathing exercises can be helpful, and eliminating inflammatory foods is key. Individualized testing for yeast infections or bacterial vaginosis can be essential if we suspect underlying chronic infections.
3. Digestion - In every case, finding each woman's optimal, individualized food plan is essential. A personalized elimination diet that is guided by one of our expert clinicians helps each woman to determine the foods that her body is uniquely sensitive to. Unfortunately, there is no "Vulvodynia Diet" because not only are each woman's food sensitivities unique, but her digestive function challenges are also unique.
You can be eating the best diet in the world, but if your stomach acid is low, your digestive enzymes are sluggish, your small intestines or bowel are inflamed, or you're constipated you can't appropriately absorb the foods you need to heal and your irritated digestive system may be irritating your vulva because it's irritated and they simply happen to live in the same neighborhood - your pelvis (there's that pesky organ cross talk!)
Individualized stool testing and other empiric testing can help us to find your best combination of foods and supplements to reduce chronic inflammation and support optimal nutrient absorption so that your body will have all of the vitamins, minerals, proteins, and fats that it needs to heal.
4. Nutrient Deficiencies - Many women with vulvodynia lack essential nutrients for the vulvar, vaginal, and pelvic tissues to function optimally. Vitamin D, omega-3 fatty acid, other antioxidant, B vitamin, and magnesium deficiencies commonly show up on nutrient deficiency and organic acids testing in my clients with vulvodynia. Restoring each woman's unique nutrient deficiencies with targeted supplementation (from companies that have high quality products) helps to maintain optimal vulvovaginal heath and general health for the long term.
5. Endocrine System - Optimal hormone balance is essential lubrication of your vulvovaginal tissues and strength of your pelvic floor muscles. Plus, having optimal stress hormone balance helps to keep the nervous system calm. Many women with vulvodynia have low estrogen, progesterone, and/or testosterone. Many struggle with high cortisol and/or low melatonin. Some women with vulvar pain also have thyroid issues and/or chronic fatigue that may be hormonally related. Again, testing to see where your hormone levels may be out of balance, helps us to figure out why they are out of balance and how to balance them from the root. Just putting topical estrogen cream on the vulva without understanding why the estrogen levels are low (and how estrogen is breaking down in the body) - and addressing that cause, is really just a band-aid fix that is unlikely to be effective in the long term.
6. Narrative Medicine - At the risk of sounding a bit "woo woo" here, once the structural, nervous system, digestive, nutrition, and hormonal factors have been addressed, it's important to tune into what your pain is trying to tell you. In fact, we usually address all 6 of these factors concurrently with each of our clients.
Many women with vulvodynia have experienced trauma - abuse, sexual trauma, birth trauma, etc. - and addressing that trauma with the help of a skilled psychotherapist who specializes in pelvic pain is key.
In addition, our skilled coaching approach helps you to work through practical stressors (whether you have had trauma or not) that are worsening your pain - anything from work, relationship or parenting challenges, to lack of feeling safe in your body or in your life. Our clients often feel a lack of safety in their bodies, lack of financial safety, or have deeply ingrained societal messages of sexuality being shameful. And, many of our clients are over giving to the point of exhaustion. Addressing these common emotional, spiritual, and practical challenges that so many women face is our specialty using coaching tools and strategies.
In narrative medicine, your stories, beliefs, support networks, perspective, unique gifts, and goals are all a part of the root cause healing process.
Using these 6 steps, you will learn so much about what your body needs to most easily tap into it's own healing ability. Your mind, body, and spirit do the healing, we just support you to create the environment in your body and life to make your healing easier, more rapid, and more complete.
In the words of one of my former patients, “In order to really receive the benefits..., you definitely need to be committed to the plan, which can be hard (especially for very active, busy women). But it is really all possible with the help of a knowledgeable and patient nutritionist, advice from a team of other medical professionals who care about you, and support from your friends and family. And finally, the most important part of successfully completing the (program), is giving yourself permission to focus on yourself, because you deserve to live a happy, healthy, and pain-free life”
Click here to read our recently published research on vulvodynia in the journal, Integrative Medicine.
In the past 17 years, my team and I have helped thousands of women with vulvodynia all over the world heal. You have the capacity to heal, we would be honored to support you along the way.
To learn more about our virtual clinic, click here. We are currently accepting new clients and referrals.
Stephanie Yeager: Passionate about spreading the word of hope and healing for those like her, influencing a paradigm shift in the medical community toward greater understanding of chronic pelvic pain disorders, and prevention initiatives that may protect young women before onset can occur.