This client was a 65-year-old retired teacher who came for physiotherapy with a gradual onset of red hot, itchy, burning pain around her vulval area.

The pain was exacerbated with sitting, and tight clothing, and was eased slightly with an ice pack. The client had been to see her GP who had prescribed oestrogen pessaries for vaginal dryness (common after the menopause) but this had made the symptoms worsen.

Vulvodynia is persistent, unexplained pain of the vulva, the skin surrounding the vagina. There is usually no obvious cause.

In her history this lady described previous pelvic pain and urgency of her bladder and also a long history of low back pain.

On assessment I found that this lady:

• Had an increased curve in her lower back which would put extra stress on the front part of her pelvic floor
• Pain on palpation at levels in her spine which corresponded with the pelvic floor nerve supply, which was worse on the left
• Pain on palpation of the pudendal nerve on the left which supplies the pelvic floor and sits underneath her buttock
• The pelvic floor displayed hypertonus (or difficulty relaxing in a resting state)
• Palpation of the left side of the pelvic floor produced her symptoms

The treatment focused on:

• Treatment of the lower back pain, which stopped the pain on palpation of the pudendal nerve
• Postural correction and exercises to reduce the stress on the pelvic floor
• Breathing exercises encouraging the pelvic floor to relax
• Self massage to the pelvic floor
• Pelvic floor “drop” exercises to relax the pelvic floor

This client had four sessions of physiotherapy over six weeks and was pain-free by the final session, but most notably was 80% improved after the first two. She felt that most of the improvement was made through the pelvic floor drop exercises. The client was recommended to continue with the breathing exercises for 15 minutes each day with a relaxation MP3.

For help with this or any other Women’s Health problems contact our clinic on 01302 511755 or email info@blizardphysiotherapy.co.uk to make an appointment with Jenny Blizard or Kate Stowers, our specialist Women’s Health Physiotherapists?.