Vulvodynia vs Vaginismus, both of these terms are common diagnoses in the world of painful sex. They are different, however, in presentation and in treatment. It is important to understand the nuanced differences so that treatment can then be successful.
Definitions:
Vulvodynia means pain in the vulva, which is external to the internal vaginal cavity. Dynia is a root coming from the word "allodynia" which means pain to innocuous touch, or pain with touch that should not be painful. For example, the brush of a finger or a tampon creating burning or sharp pain would be a hallmark sign of vulvodynia.
Vaginismus, on the other hand, is characterized by a partial or fully spasm-closed vaginal cavity due to pelvic floor muscle involuntarily contractions. This can be primary vaginismus, which starts in childhood and is often found when a young girl tries to first put a tampon in. This can also be secondary vaginismus, which comes on after an event, such as sexual assault, or periods prolonged stress and trauma. Read more on our blog about vaginismus here.
Another commonly used term in this space is also dyspareunia, which just means painful sex.
Which providers should you see?
Both vulvodynia and vaginismus should be treated with a multimodal approach where you and a team of professionals help you reach your goals. This team should consist of a medical provider like an OBGYN, a pelvic floor physical therapist or occupational therapist, and a mental health counselor such as sex therapist.
Each one brings a special skillset to the table that is needed in treating these complex cases.
OBGYN: Can assess your pelvis and run labs to make sure you don't have any infections or abnormal tissues. Infections and other systemic diseases can lead to pain, so it is important to first rule them out before proceeding with treatment. They also can prescribe you any medication that may be helpful to your therapy treatment, such as topical estrogen or muscle relaxant suppositories.
Pelvic Floor PT: They assess your neuro-musculoskeletal structure and function of your pelvis, hips, back, trunk etc. Sex and penetration are a function of the pelvic floor muscles, and if any nerves or muscles are in pain and impacting this important function then you would benefit from working with a skilled pelvic PT or OT. They will help the nerves calm down, and the muscles to relax.
Mental Health: It is highly recommended this provider be both trauma-informed, and a sex therapist if possible. If not, someone who is experienced in treating anxiety and relationships can be another option. There is such a huge psychological connection between sex and identity, confidence, fear, past trauma etc that not addressing this side of the equation can often be why individuals fail treatment.
Treatments for Vulvodynia:
Since vulvodynia is largely rooted in nerve pain, it is important to understand that dilators or dilator therapy are not the appropriate treatment. If anyone does prescribe dilators to you, they may either think you have vaginismus or are not aware of current research and best practice.
Put simply, you have to tackle the nerves and nerve pain from multiple angles.
Medically: You may benefit from topical estrogen cream or a vaginal moisturizer with hyaluronic acid in it to soothe the irritated tissues. Pissed off tissues piss of nerves. You may also have a history of chronic infections, which also create nerve pain, and in this case you may need interventions that help you prevent recurrent infections. This might look like vaginal probiotics or boric acid suppositories. Please consult your OBGYN or PCP regarding all of these before actually trying them out.
Psychologically: You may need to work with a mental health professional on rewiring the way your body and nervous system interact with the world, and interact with the body. Even before you see a therapist, or in conjunction, it is helpful to practice mindfulness, meditation, deep breathing, and healthy practices such as getting enough sleep. This is not to say that your pain is all in your head, but the perception of pain is just that, a perception. If the brain and spinal cord are hardwired to upregulate any signal seen as threatening, it will become just that. Improving your nervous system's perception of pain comes from healing the body and its tissues, and the mind's perception of the body.
Physically: Nerves and muscles, as well as other connective tissue, can indeed feel pain and continue to perpetrate signals of pain even if the tissue does not have damage. Working through nerve pain for vulvodynia physically may look like learning how to move nerves to calm them down, desensitize the tissue with biofeedback and touch, stretch the muscle tissue to prevent spasms around nerves, and improve the way you move through the world to promote tissue resiliency. For example, maybe stop constantly clenching your glutes, those nerves underneath will thank you for it.
I'll be the first to admit, despite this diagnosis very much needing a multimodal approach, it is hard for individuals to find all three of these providers close to them or accessible to them. As a pelvic floor PT myself, I can confidently say that no therapist is the same and no treatment approach is completely the same. I have unfortunately seen patients who have already seen other PT's where they haven't gotten better for one reason or another.
This is why I specifically created an online program designed for individuals to treat their vulvodynia and painful sex at home. It does not replace in person care, but it includes absolutely everything I ever give any of my patients to do at home. If you're interested in learning more about how to treat vulvodynia at home, check the program out here.
If you feel like this program is just what you needed, then use the coupon code 'blog' to get 20% off.
Treatments for Vaginismus:
I cover this topic extensively in my blog on How to Treat Vaginimus At Home, which I highly recommend checking out if you're wanting to learn more about this diagnosis.
TLDR:
Vulvodynia is pain, often sharp and burning, in the vulva which is outside of the vaginal canal. Typically these individuals can receive penetration, it is just extremely painful. Vaginismus is a partial or fully closed vaginal canal due to the pelvic floor muscles spasming continuously. They cannot receive penetration even if desire, or barely can. They may also have nerve pain in the vulva. Yes, unfortunately, these two diagnoses can occur together.
Understanding the differences is important because the treatments for the two look different.
If you're interested in learning how to treat vaginismus at home, or treat vulvodynia at home, check out my online program here and use coupon code 'blog' for 20% off.
Caroline Gamwell, DPT is a Doctor of Physical Therapy specializing in Pelvic Health and Orthopedics. Dr. Gamwell earned her doctorate at Northwestern University in Chicago, IL with a focus on chronic pain rehabilitation. Dr. Gamwell owns Worth It PT, LLC, a boutique physical therapy practice based in Denver, CO focusing on all things pelvic health. She holds post-graduate certifications in Pelvic Floor Physical Therapy, as well as in treating pregnant and postpartum athletes. Her strongest passions lie with helping others conquer their chronic pain and achieve their intimacy goals.