Vulvodynia Physiotherapy in Clapham

Vulvodynia is pain in the vulva, the area around the outside of the vagina, that lasts at least three months and doesn’t have another clear cause such as an infection or skin condition. Symptoms can include:

• Burning, stinging, rawness or soreness
• Throbbing or stabbing pain
• Pain with touch or pressure, such as sex, inserting a tampon, tight clothing or sitting
• Pain that’s there all the time, or comes and goes without a trigger

It can affect the whole vulva or just one area, and the pain may spread to nearby areas such as the inner thighs.

Provoked vestibulodynia

Pain at the vestibule, the area just around the entrance to the vagina, triggered by touch or pressure, for example during sex, inserting a tampon or a smear test. It’s the most common type and a common cause of painful sex.

Generalised vulvodynia

Pain across a wider area of the vulva, often present without touch, and sometimes constant.

Mixed vulvodynia

Some women have both: pain that’s there much of the time and gets worse with touch.

There’s often no single cause. The NHS describes several possible factors:

Nerve sensitivity

The nerves in the vulva can become irritated or over-sensitive, so normal touch is felt as pain.

The pelvic floor

Pelvic floor muscles that aren’t working well, whether tense and overactive or weak, are common in vulvodynia and can help keep pain going. This is where physiotherapy helps most directly.

Previous infections and irritation

Repeated thrush or other infections, or irritation from products, can sometimes trigger ongoing sensitivity.

Hormonal changes

Lower oestrogen, for example around menopause or while breastfeeding, can make the vulval tissues more sensitive.

Stress and the pain cycle

Pain, anxiety and muscle tension can feed each other. Breaking that cycle is an important part of treatment.

Vulvodynia often responds best to a combination of treatments, and physiotherapy works well alongside care from your GP or a vulval specialist. Your plan may include:

• Pelvic floor relaxation: breathing and down-training to release tension and calm the pain response
• Manual therapy: gentle techniques to ease muscle and tissue tension, only with your consent
• Desensitisation: graded touch and, if appropriate, vaginal dilators to help the area tolerate pressure again
• Understanding your pain: how nerve sensitivity works, which helps reduce fear and flare-ups
• Practical strategies: for sex, smear tests, sitting, exercise and clothing

Olivia can also advise when it may help to discuss pain-relieving creams, medication or psychological support with your GP.

Be gentle with your skin

Wear loose cotton underwear, wash with plain water and avoid scented soaps, bubble baths, douches, wipes and very hot baths.

Manage pressure and friction

Take breaks from long periods of sitting, and try a cushion if sitting is painful. Some women find pads more comfortable than tampons.

During sex

Use plenty of lubricant, try positions where you control pressure and depth, and remember that intimacy doesn’t have to include penetration while you recover.

Look after your stress levels

Relaxation, breathing and mindfulness can help calm the nervous system and reduce flare-ups.

Talking about vulval pain can feel difficult, so we keep things relaxed and private. Your first appointment lasts 60 minutes at our Clapham clinic. Olivia will:

• Talk through your symptoms, history and goals, sharing only what you’re comfortable with
• Explain how nerve sensitivity and the pelvic floor can contribute to pain
• Discuss whether an examination would be helpful. An internal examination is always optional, and it’s your choice whether and when to have one
• Agree a plan with you, so you know what to expect next

You’re in control throughout, and you can pause or stop at any time.

Vulvodynia usually improves gradually rather than all at once. Many women notice fewer flare-ups and less tension within a few months, and progress tends to build steadily with a combined approach. Olivia will review your progress at each appointment.

See your GP, a sexual health clinic or a vulval clinic about vulval pain, so other causes such as thrush, infections or skin conditions like lichen sclerosus can be ruled out. Seek advice promptly if you notice sores, lumps, skin changes, unusual discharge or bleeding. Your GP can refer you to a specialist vulval clinic if needed, and Olivia will refer you on if anything in your assessment needs medical review.