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

Slide 21 (28:41)    Desensitisation (continued)

This is just a picture that shows some of the vaginal dilators. I have to say I don’t use these that often: it’s not normally that somebody has an anatomically small vagina that needs stretching - I mean, it can be a problem for some people, but in terms of the patient group that I see… But sometimes there is a place for dilators, and we do sometimes recommend their use. I think they can be really helpful when they’re used for desensitisation purposes, because they come in different sizes, and you can sort of gradually work your way through the options that are there from a size point of view. Again, they’re not very friendly-looking, and I do apologise for that. They’re very clinical.

Slide 22 (29:22)    Relaxation and lifestyle

Relaxation and lifestyle are just worth touching on. I do find that there is some benefit from using general relaxation techniques as part of the physio approach. We use something called the Laura Mitchell method quite a lot, which is really just a whole body technique, where what you’re trying to do is to take the body out of positions that are classically associated with stress and tension into positions associated with relaxation, the idea being that if you can improve your general body awareness, and reduce tension in other parts of your body, that you will get some carryover into your pelvic floor, and some increased awareness into your pelvic floor muscles. We tend to include general exercise advice in what we do, and that may be recommending that somebody include something like yoga or Pilates in their routine. Some people hate yoga, some people love it, but I think just some sort of exercise that improves your general body awareness is really useful. Pilates very much focuses on pelvic floor muscle awareness and activity, and so I think for some women, there’s a lot of benefit to be gained with that as well. Self-awareness and stress management – really that was just touching on what I mentioned before about some people having a tendency to carry stress in their pelvic floor and needing to be aware of that. Obviously I would always cover general vulval care advice, point people in the direction of the Vulval Pain Society website and handbook and so on.

Slide 23 (30:53)    Musculoskeletal problems

It’s also possible that somebody has coexisting problems with other parts of the musculoskeletal system, and as I mentioned before, this may be other types of chronic pelvic pain, lumbar nerve root compression, trigger points in other muscles, sacroiliac joint dysfunction, sacral torsions – there’s a whole host of other conditions that can occur side by side with vulval pain conditions, and the great thing is that a Women’s Health physiotherapist hopefully should be skilled and experienced in treating all of these conditions. It’s not usually that you would have to see a whole bunch of different physios to get this tackled, although you will usually find that Women’s Health physios do work closely with other specialties, musculoskeletal physiotherapists and the pain specialist physios as well, so there usually is scope for referral across disciplines if it’s necessary.

Slide 24 (31:48)    Bladder and bowel problems

Again, this has been mentioned before, but we do also find that there is a common existence of bladder and bowel problems that we do see alongside vulval pain. Physio is able to help with the management of all of these conditions as well, whether it’s painful bladder, overactive bladder, irritable bowel syndrome, chronic constipation, a whole host of things that physio is in a really good position to be able to treat as well.