vulvodynia do_s

Vulvodynia: Do’s, Don’ts, + Symptom Management

In Vulvodynia by Stephanie PrendergastLeave a Comment

 By Stephanie Prendergast, MPT, Cofounder, PHRC Los Angeles


The diagnosis of Vulvodynia can be confusing, scary, and overwhelming. Studies show that vulvar pain affects as many as 1 in 3 women at some point during their lives and the medical community is finally getting better at diagnosing and treating it!

‘Vulvodynia’ simply means pain in the vulva. We consider ‘Vulvodynia’ to be an anatomic descriptor more than a diagnosis, there are a number of treatable causes of vulvar pain and effective care needs to be individualized. For the sake of this blog we are sharing general Do’s and Don’ts that can help the majority of people with vulvar pain regardless of the reason they have it. If you need more specific information about your specific case we are available online and in-person to help!



  • Always get tested if you suspect infection
    • Symptoms such as itching and burning can be caused by vaginal infections, however, assuming it is an infection without testing it can result in a delay of diagnosis! If the cultures are negative there are other reasons for the symptoms and these reasons will be missed if something that is not an infection gets treated like an infection.
  • Wash your vulva with water
    • Soaps contain irritating dyes and substances are not needed for great vulvar health!
  • Use a dilator when your tissues are healed
    • There is a lack of guidance about how to best use dilators and as a result people may start using them too early in their treatment plan or incorrectly. We recommend working with an expert to help make best use of the dilators when they are right for you. 
  • See a pelvic floor physical therapist
  • See a vulvar medical specialist
    • Most general gynecologists, internists, and urologists have not had advanced vulvar sexual medicine training like sexual medicine experts have. If symptoms are not improving it makes sense to seek out care from an expert that specializes in sexual medicine. ISSWSH and North American Menopause Society (NAMS) have Find a Provider lists and they are trusted sexual medicine societies!



  • Don’t assume you have a yeast infection
    • Always get tested to  know for sure!
  • Don’t use Over The Counter (OTC) yeast creams
    • Certain OTC treatments for yeast can cause allergic reactions and persistent vulvar pain. As we stated multiple times, it may not even be a yeast infection so we advise skipping OTC remedies, particularly those that can have persistent and problematic side effects
  • Don’t scrub your vulva with soap
    • Our vulvar tissue does not need to be scrubbed or subjected to soap to be healthy!
  • Don’t use a dilator if you have vestibulodynia
    • Sometimes the vulvar tissues are fragile and hypersensitive and dilators may not be therapeutic until the tissue health is improved. If something does not feel right it may be because the timing, size, frequency, or duration of dilator use is more than the tissues can tolerate in their current state. 
  • Don’t douche
    • This feels very 10 years ago. Unless douching is prescribed for a medical reason by an expert medical provider for a confirmed medical diagnosis the majority of people do not benefit from douching and in fact it can be harmful to our vaginal biomes. 


vulvodynia symptoms


  • FYI The majority of those with vulvodynia have tight pelvic floor muscles! Relaxing or ‘dropping’ these muscles can help alleviate pelvic floor tightness, reducing pain.
  • Inhalation lengthens our pelvic floor muscles, exhalation shortens them. Diaphragmatic breathing is a gentle, effective way to move our pelvic floor muscles without straining them.⠀
  • Heat and sitz baths can be soothing on vulvar tissues. Plus, baths rock. ⠀
  • Child’s pose widens the space between our sit bones, helping to lengthen the pelvic floor muscles. Try diaphragmatic breathing in the child’s pose position if you have tight muscles!⠀
  • Did you know that the piriformis and obturator internus muscles are part of the pelvic floor? Foam rolling these muscles can help reduce tension in the external portions which will in turn help relax the pelvic floor muscles and help reduce vulvar pain! 

Managing vulvodynia symptoms may feel like an uphill battle, but with the right approach and knowledge, it is possible to find relief. Remember, every body is unique and what works for one person may not work for another. It’s crucial to remain patient, open-minded, and proactive in your journey towards pain management.

Utilize the strategies we’ve discussed in this blog, such as lifestyle changes, pelvic floor therapy, and mindfulness techniques, and don’t hesitate to seek professional help when needed. The journey towards reducing vulvodynia symptoms is just as important as the destination itself. 

Vulvodynia Resources

Pelvic Pain Explained: Vulvodynia + Resource List

Vulvodynia, Vestibulodynia, and Vaginismus: what’s the difference and why does it matter?

Vulvodynia, Vestibulodynia, Vaginismus…What’s the Difference??? (video)

5 Tips to Reduce Vulvodynia Symptoms

A Biopsychosocial Approach to Vulvodynia

Success Story: How Diane beat Vulvodynia



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What are pelvic floor muscles?

The pelvic floor muscles are a group of muscles that run from the coccyx to the pubic bone. They are part of the core, helping to support our entire body as well as providing support for the bowel, bladder and uterus. These muscles help us maintain bowel and bladder control and are involved in sexual pleasure and orgasm. The technical name of the pelvic floor muscles is the Levator Ani muscle group. The pudendal nerve, the levator ani nerve, and branches from the S2 – S4 nerve roots innervate the pelvic floor muscles. They are under voluntary and autonomic control, which is a unique feature only they possess compared to other muscle groups.

What is pelvic floor physical therapy?

Pelvic floor physical therapy is a specialized area of physical therapy. Currently, physical therapists need advanced post-graduate education to be able to help people with pelvic floor dysfunction because pelvic floor disorders are not yet being taught in standard physical therapy curricula. The Pelvic Health and Rehabilitation Center provides extensive training for our staff because we recognize the limitations of physical therapy education in this unique area.

What happens at pelvic floor therapy?

During an evaluation for pelvic floor dysfunction the physical therapist will take a detailed history. Following the history the physical therapist will leave the room to allow the patient to change and drape themselves. The physical therapist will return to the room and using gloved hands will perform an external and internal manual assessment of the pelvic floor and girdle muscles. The physical therapist will once again leave the room and allow the patient to dress. Following the manual examination there may also be an examination of strength, motor control, and overall biomechanics and neuromuscular control. The physical therapist will then communicate the findings to the patient and together with their patient they establish an assessment, short term and long term goals and a treatment plan. Typically people with pelvic floor dysfunction are seen one time per week for one hour for varying amounts of time based on the severity and chronicity of the disease. A home exercise program will be established and the physical therapist will help coordinate other providers on the treatment team. Typically patients are seen for 3 months to a year.

What is pudendal neuralgia and how is it treated?

Pudendal Neuralgia is a clinical diagnosis that means pain in the sensory distribution of the pudendal nerve. The pudendal nerve is a mixed nerve that exits the S2 – S4 sacral nerve roots, we have a right and left pudendal nerve and each side has three main trunks: the dorsal branch, the perineal branch, and the inferior rectal branch. The branches supply sensation to the clitoris/penis, labia/scrotum, perineum, anus, the distal ⅓ of the urethra and rectum, and the vulva and vestibule. The nerve branches also control the pelvic floor muscles. The pudendal nerve follows a tortuous path through the pelvic floor and girdle, leaving it vulnerable to compression and tension injuries at various points along its path.

Pudendal Neuralgia occurs when the nerve is unable to slide, glide and move normally and as a result, people experience pain in some or all of the above-mentioned areas. Pelvic floor physical therapy plays a crucial role in identifying the mechanical impairments that are affecting the nerve. The physical therapy treatment plan is designed to restore normal neural function. Patients with pudendal neuralgia require pelvic floor physical therapy and may also benefit from medical management that includes pharmaceuticals and procedures such as pudendal nerve blocks or botox injections.

What is interstitial cystitis and how is it treated?

Interstitial Cystitis is a clinical diagnosis characterized by irritative bladder symptoms such as urinary urgency, frequency, and hesitancy in the absence of infection. Research has shown the majority of patients who meet the clinical definition have pelvic floor dysfunction and myalgia. Therefore, the American Urologic Association recommends pelvic floor physical therapy as first-line treatment for Interstitial Cystitis. Patients will benefit from pelvic floor physical therapy and may also benefit from pharmacologic management or medical procedures such as bladder instillations.

Who is the Pelvic Health and Rehabilitation Team?

The Pelvic Health and Rehabilitation Center was founded by Elizabeth Akincilar and Stephanie Prendergast in 2006, they have been treating people with pelvic floor disorders since 2001. They were trained and mentored by a medical doctor and quickly became experts in treating pelvic floor disorders. They began creating courses and sharing their knowledge around the world. They expanded to 11 locations in the United States and developed a residency style training program for their employees with ongoing weekly mentoring. The physical therapists who work at PHRC have undergone more training than the majority of pelvic floor physical therapists and as a result offer efficient and high quality care.

How many years of experience do we have?

Stephanie and Liz have 24 years of experience and help each and every team member become an expert in the field through their training and mentoring program.

Why PHRC versus anyone else?

PHRC is unique because of the specific focus on pelvic floor disorders and the leadership at our company. We are constantly lecturing, teaching, and staying ahead of the curve with our connections to medical experts and emerging experts. As a result, we are able to efficiently and effectively help our patients restore their pelvic health.

Do we treat men for pelvic floor therapy?

The Pelvic Health and Rehabilitation Center is unique in that the Cofounders have always treated people of all genders and therefore have trained the team members and staff the same way. Many pelvic floor physical therapists focus solely on people with vulvas, this is not the case here.

Do I need pelvic floor therapy forever?

The majority of people with pelvic floor dysfunction will undergo pelvic floor physical therapy for a set amount of time based on their goals. Every 6 -8 weeks goals will be re-established based on the physical improvements and remaining physical impairments. Most patients will achieve their goals in 3 – 6 months. If there are complicating medical or untreated comorbidities some patients will be in therapy longer.

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