Vulvodynia: Assessment and Treatment

Vulvodynia, as defined by the International Society for the Study of Vulvar Disease (ISSVD), is “vulvar discomfort, most often described as burning pain, occurring in the absence of relevant visible findings or a specific clinically identifiable, neurologic disorder.” Numerous hypotheses have suggested possible etiologies but there is still no consensus of a definitive cause or a recommended intervention protocol. We know that as many as 12% of women in the US will complain of having chronic vulvar pain lasting longer than 3 months. Although some women will find their symptoms resolve on their own, many patients will suffer for years, often going undiagnosed, misdiagnosed, untreated, and/or mistreated. Over time, multiple organ systems become involved, creating a vicious cycle of pain, visceral and sexual dysfunction, and reduced quality of life.

The literature suggests that the most successful approach to treating vulvodynia is a multidisciplinary approach. Pelvic rehabilitation therapists are an integral part of the multidisciplinary treatment team. With thorough PT assessment, multiple comorbid dysfunctions are often uncovered, including those in the musculoskeletal, myofascial, and visceral systems in and around the pelvis. By addressing and treating these comorbid dysfunctions, pelvic rehabilitation providers can successly impact vulvar pain through reduced symptoms, improved function, and improved quality of life.

The 2-day continuing education course will begin with the history of vulvodynia, and course highlights will include epidemiology, nomenclature, and current medical management of chronic vulvar pain. In-depth anatomy of the pelvis and abdomen will be instructed followed by suggested strategies for assessment and treatment of female pelvic pain. Instructed evaluation and intervention approaches will include associated muscular, myofascial, and visceral components. A brief review of sexual function will be presented along with an introduction to addressing sexual dysfunctions such as dyspareunia with your patients. Therapists will find and abundance of manual therapy techniques included in this course, and in addition to external and internal abdominopelvic approaches, lab activities will include both vaginal and rectal internal pelvic muscle techniques.

As the course will include both lab and lecture portions, all attendees should be prepared to participate as both practitioner and patient. Both the anterior and posterior pelvis will be assessed and treated internally. Should males be interested in attending, they will need to provide their own models for the lab portion of the course.

Audience:

This continuing education seminar is targeted to physical therapists, occupational therapists, physical therapist assistants, occupational therapist assistants, registered nurses, nurse midwives, and other rehabilitation professionals. Content is not intended for use outside the scope of the learner's license or regulation. Physical therapy continuing education courses should not be taken by individuals who are not licensed or otherwise regulated, except, as they are involved in a specific plan of care.

Prerequisites:

None

Pre-Readings:

The Vulvodynia Guideline (click to download) and Chronic Pelvic Floor Dysfuncton, Best Practice & Research Clinical Obstetrics and Gynaecology 28 (2014)