Pelvic Pain

Publisher Summary Vulvar pain is common in women and the etiology may be multifactorial. A detailed history, careful physical examination, appropriate laboratory testing, and histologic evaluation will aid in establishing the diagnosis. This chapter focuses on the causes and treatment of vulvar pain. Levator ani spasm (LAS), or hypertonus of the levator ani muscles, is a common finding in women with vulvar pain. In fact, patients with vestibular pain in general have increased resting tone and decreased contraction tone of the pelvic floor muscles. LAS may be diagnosed by digital examination using one finger. The finger is gently inserted through the hymen and the levator ani muscles are systematically palpated for evidence of pain, hypertonus, or trigger points, indicating pelvic floor dysfunction. Physical therapy is highly effective in decreasing levator ani hypertonus, in normalizing muscle tone, increasing pelvic floor strength, desensitizing local tissues, and improving vulvovaginal elasticity. The range of treatments administered by a physical therapist includes internal (vaginal and rectal) and external soft tissue mobilization and myofascial release; trigger-point pressure; visceral, urogenital, and joint manipulation; electrical stimulation; therapeutic exercises; active pelvic floor retraining; biofeedback; therapeutic ultrasound; and home vaginal dilation. With the aid of a biofeedback machine, women can view a display of numbers on a meter, or colored lights, to assess the tension in their muscles.