Transcript of VPS Podcast 4 - Physiotherapy treatment for vulval pain: a presentation given by Helen Forth

Slide 18 (24:11)    Biofeedback equipment

Excuse the slightly blurry pictures, but I just wanted to include a few bits of equipment here for you to actually be able to see them. In clinic use, you’ll probably see something like this, which is a desktop PC that’s got all the bits of kit attached to it. The screen is where you would see those graphs that I was just showing you. We have one of these at the Royal Free. A lot of Women’s Health Physiotherapy departments now have this particular piece of kit - there are other bits out there, but just as an example of something that’s quite commonly used. This is an example of a home unit that you might see, and in fact I’ve got one with me that you can have a look at if you’re interested, and then these are some of the probes. So, the anal one that I was talking about that’s smaller than a lot of the vaginal probes is this: something called an ‘Anuform’. They’re not particularly friendly-looking, and I apologise for that. I think it’s something that does need a bit of work. There is actually some quite interesting development going on at the moment looking at probes for biofeedback specifically for women who’ve got pain syndromes, and in fact I know of somebody who’s in the process of developing – I think it’s due to come out next year – a probe that’s actually made of foam rather than a hard plastic probe, which sounds like it ought to be much more comfortable to use if you’ve got pain, so watch this space as far as that’s concerned.

Slide 19 (25:38)    Biofeedback self-help measures

Biofeedback self-help: so, a home biofeedback unit – from us at the Royal Free, anyway, we can loan out home units to patients to trial. A lot of patients do go ahead and buy them themselves. They’re not massively expensive to buy: about £85 if you buy them as a patient, because you get them VAT-free. If we buy them for you, actually we get charged VAT, so it’s more expensive that way round - it’s actually better to buy it directly as a patient, and there are several companies who produce bits of kit that can be used. Again, I would say use them under guidance of a physiotherapist rather than going off and buying your own kit and just having a go at using it without any supervision – I would really encourage you to get it looked at properly and to know that you’re using it effectively and safely and so on. The home kits can be used with the same probes that we use with you when we do biofeedback with you in a clinic setting, which is good, and the biofeedback units can be set so that they match your capabilities in terms of the length of time you’re able to hold a pelvic floor contraction for and the number of repetitions you’re able to do, and so on, so that can work really well. They display resting tone and contraction strength, and then as I was saying before, you can have a combination of lights and noises and numbers that provide feedback, that can really help you to learn how to use your pelvic floor effectively.

Slide 20 (27:09)    Desensitisation

Just quickly, desensitisation basically just means decreasing hypersensitivity, and Andrew talked earlier about how we can have a pain memory - we can become oversensitive if we’ve got pain. You can start to learn that any kind of touch or stimulation in that part of your body is going to be painful, and desensitisation is a technique that’s used to help to overcome that, really. It includes things like self-examination; it includes gradual guided insertion of probes, so you might start off by using one of the smaller anal probes and then progress to using a bigger vaginal probe. It may include the use of vaginal dilators, and I’m sorry I haven’t got time to elaborate hugely on all of this. It may be required before you do EMG biofeedback: it may be that you need to go through some desensitisation work before you’re at a point where you can tolerate inserting and keeping in place a vaginal probe for the length of time that’s required to do the biofeedback, so sometimes this does have to come first. It should always be done within the limits of the patient’s pain, and obviously what you’re aiming for is a positive experience of insertion. If it hurts when you try to insert something, all that’s going to do is reinforce the idea that it’s always going to hurt, so I always say to patients: if it hurts, stop! I think that’s really important. And as I said, under physio guidance.