Report from the Vulval Pain Society Super Workshop held at The Royal College of Obstetricians and Gynaecologists, London, 4 December 2010

This conference report summarises the day we had in London at our annual Super Workshop. The day was for disseminating information to patients and a little different from the workshops that we have had in the past. The workshop was packed with key health professionals working within the field of vulval health and where better to have the conference than in the Royal College of Obstetricians and Gynaecologists - a medical college dedicated to the health of women! 105 women and partners came, of whom around 20% were health professionals. This was a great turn out in view of the snow which had prevented many from attending.

Dr Karen Gibbon, a Consultant Dermatologist working at Whipps Cross Hospital, gave an overview of vulval problems, commenting on the normal vulva including different anatomical appearances. She commented on the confusion between the vagina and the vulva and how so often especially in the press the two are mixed up. The vagina is a hollow muscular tube and the vulva is the outer genital skin where problems can arise such as skin disease and vulval pain. Dr Gibbon gave us a graphic presentation of the variety of different vulval problems that she sees in her vulval clinic, commenting that the vulva is another area of skin, and skin disease on other sites of the body can also affect the vulva, e.g. psoriasis and eczema. There were many clinical slides to see but the general feeling from delegates was that this was important to give a realistic picture of vulval disease rather than the non-realistic picture given by the internet.

Dr Gibbon's self-help tips included:

• Avoid soap/fragranced products directly on the vulva
• Use an emollient to wash with and reapply regularly
• Ask for vaginal and vulval swabs (+/- MSU) if antifungals are not helping
• Throw away your thongs
• Get a mirror and take a good look

Dr Gibbon spoke passionately about the experiences of patients with vulval problems. She had two asks of the audience. First of all, Channel 4 is planning to film another episode of 'Embarrassing Bodies' and she is looking for a willing volunteer to come forward to go on the show to be filmed. This would involve a vulval examination. This has been carried out before by Fabia Brackenbury of the Vulval Health Awareness Campaign. Secondly, Dr Gibbon would appreciate feedback on the form that they are currently using in clinic: she'd like to improve it so that it is even more beneficial. You can download the form from the VPS website and then email us at This email address is being protected from spambots. You need JavaScript enabled to view it. or post it to our PO Box.

Dr Andrew Baranowski is a Consultant in Pain Management at the University College of London. He focused on the mechanism of pain those women with vulvodynia experience. The origins of pain in vulvodynia remain unknown but perhaps physical, psychological, sexual, stress and even genetic factors could play a role. He touched on the negative effects that pain has on the individual which include 1) thinking about the pain (cognition), 2) unhelpful behaviour related to pain (e.g. less physical activity) and 3) sexual and emotional consequences. There were two key words from his talk on pain: MEMORY of pain and AMPLIFICATION of pain. The mind can store memories of painful events and this can in turn lead to certain activities, events and actions triggering a flareup of the pain by activating the pain detecting nerve endings in the skin (called nociceptors). A chemical reaction in the skin causes this. In addition, the perception of pain can be amplified in certain situations so the pain experience is increased. This might happen in a number of situations such as stress, focusing on the pain and the absence of distraction. The medical term allodynia can be applied to vulval pain: this is when you feel sensations as pain that you should not normally be able to feel as such.

Helen Forth is a Women's Health Physiotherapist working at the Royal Free Hospital. She outlined the problems of the pelvic floor muscles that are seen in women with vulvodynia. In her work she finds the pelvic floor muscles (levator ani) are not only tightly contracted (hypertonic) but also weak. She discussed a number of specific and also holistic strategies to overcome this, including pelvic floor muscle rehabilitation, such as pelvic floor exercises to reduce muscle tension and trigger point therapy for tight muscles which involves a vaginal examination to relieve knots in the muscle. Biofeedback was also discussed. This is a technique that trains people to change a bodily function by controlling certain bodily processes that normally happen involuntarily, such as heart rate, muscle tension, and skin temperature. In vulvodynia a vaginal probe measures muscle activity and displays it on a monitor. This feedback to the patient can be used to control the problem which in vulvodynia can be vaginal muscle spasm.

Mr Brent Osborn-Smith gave a clear overview of osteopathy and outlined the different types of osteopathy (classical, craniosacral osteopathy and visceral osteopathy). Treatment can be used for a wide variety of problems, including pain. Acupuncture was discussed and he covered the different types of acupuncture including classical Chinese acupuncture (often given with herbs), western medical acupuncture, trigger point acupuncture and electro acupuncture.

Dr Alexandra Mizara, a Clinical Psychologist working at the Royal Free Hospital, gave an excellent overview of cognitive behavioural strategies for vulval pain. Cognitive behavioural approaches aim to improve the way that an individual manages and copes with their pain, rather than finding a biological solution. The approach is very much related to problem solving and returning control to the sufferer. Many patients state that the pain rules their lives and cannot see how this can change without a medical cure. However, with appropriate instruction in a range of pacing techniques, cognitive therapy to help identify negative thinking patterns and the development of effective challenges, stretching and exercising to improve physical function, careful planning of tasks and daily activities, and the judicious use of relaxation training, many people find the treatment enables them to take back control of their lives, to do more and feel better. Dr Mizara discussed the importance of the balance of human needs: basic, spiritual, vocational, and social. She teaches acceptance of the pain to patients, i.e. trying to get patients to see things as they are at the moment.

Sally Turner from the London Vulval Pain Support Group spoke about her personal journey through and with vulval pain and how a caring sexual partnership was of benefit to her. She emphasised the positive aspects that can be gained even though she was living with pain and the importance of a good support network. 

Finally, we were thrilled to have Professor Wendy Reid, who is the Vice President of the Royal College of Obstetricians and Gynaecologists talk on the training issues that medical doctors have in relation to vulval disease. Prof Reid also runs a vulval clinic in London at the Royal Free Hospital. There is a syllabus that doctors must follow with regard to vulval disease and they are tested on their knowledge. In her capacity as Vice President of Education for doctors, Prof Reid is very keen for vulval disease to remain a priority.

We hope to have another annual day in December 2011. Please keep an eye out on the website for more information on dates and venues.