Vulvodynia affects over 14 million women in the US alone.
Vulvodynia can be a frustrating condition to treat, because vulvodynia simply means pain in the vulva (or specifically in the vulvar vestibule), the name of the condition alone doesn’t tell us much about the root cause of vulvodynia.
If vulvodynia is provoked, then it’s only bothersome when the tissue is irritated, such as 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.
Like any other chronic pain condition, vulvodynia has body, mind, and spirit components. My clients usually find it easier to start with creating optimal conditions in the body, as physical changes are often easier to make than emotional or spiritual changes.
The 6 steps that we work through to resolve vulvodynia from the root cause with each of our unique clients.
There are muscles just inside of the vulva that support the vagina, bladder, rectum, and are an integral part of the pelvic structure. Just like any other muscles, these can be tight, weak, and/ or in spasm. Working with a highly skilled pelvic floor physical therapist can help to find specific muscular or soft tissue issues for each woman. Then, a specific program of exercise, muscular relaxation techniques, manual therapy, or self-massage – sometimes combined with energy work, visualizations, affirmations, or breathwork can relax, stabilize, and strengthen the tissues.
Nervous System Quieting
Many people with chronic pain live in a state of “fight or flight.” If the 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 the reproductive organs, bladder or colon, strategies that help to calm the nervous system allow the body to become less sensitive to irritating stimulation that can contribute to pain. Each women needs 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, bacterial vaginosis, or other more rare microbes can be essential if we suspect underlying chronic infections. There are also tests available for environmental toxin stress, that can sometimes be helpful.
In every case, finding each woman’s optimal, individualized food plan is essential. A personalized elimination diet that is guided by an expert clinician 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. She can be eating the best diet in the world, but if her stomach acid is low, her digestive enzymes are sluggish, her small intestines or bowel are inflamed, or she’s constipated, she can’t appropriately absorb the nutrients necessary for healing the irritated digestive system, which may be irritating the vulva. Because the vulvovaginal region is close to the colon and rectum, if one is irritated, the other can be irritated simply by organ cross talk.
Individualized stool testing and other empiric testing can help us to find each individual’s best combination of foods and supplements to reduce chronic inflammation and support optimal nutrient absorption to give body all of the vitamins, minerals, proteins, and fats that it needs to heal.
Many women with vulvodynia lack essential nutrients for the vulvar, vaginal, and pelvic tissues to function optimally. Vitamin D, omega-3 fatty acids, other antioxidants, 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.
Some nutrients with the best evidence base to generally reduce chronic pain include:
Omega-3 Fatty Acids – 3000mg total daily (in 2-3 doses)
Vitamin D3 (best if taken with Vitamin K2) – 2000IU – 5000IU daily
You can get high quality omega-3 fatty acids and Vitamin D3, here, with 2-3 capsules per day.
Antiinflammatory polyphenols… I like this combination 2 capsules daily.
Optimal hormone balance is essential for lubrication of the vulvovaginal tissues and strength of the 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 root cause cause is really just a band-aid fix that’s unlikely to be effective in the long term.
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 the pain is trying to “say.” 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 clients to work through practical stressors (whether they have had trauma or not) that can be contributing to the pain… anything from work, relationship or parenting challenges, to lack of feeling safe in her body or in her 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 overgiving 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, a woman’s stories, beliefs, support networks, perspective, unique gifts, and goals are all a part of the root cause healing process.
Using these 6 steps, our clients learn what their unique bodies, minds, and spirits need to tap into her body’s own healing ability. The woman’s mind, body, and spirit do the healing, we just support them to create the environment in her body and life to make healing easier, more rapid, and more complete.
In the words of one of my former clients, “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”
Read on to learn more about the specifics of one of our client’s unique pelvic pain recovery journeys. We recently published her case in the peer reviewed journal, Integrative Medicine, A Clinician’s Journal.