Over the years we’ve treated a wide variety of pelvic floor syndromes at PHRC, and one of the things we’ve learned is that every case is different. Therefore, there is no such thing as a one-size-fits-all treatment plan. We hope that our new “Case Study” section will help to drive this important reality home.
Every couple of months we will be adding a new case study to the blog. Our first case study was about a male patient with pelvic floor dysfunction as well as the treatment program that was successful in getting him pain-free. Today’s case study focuses on the evaluation and treatment of a patient that came to the clinic with a diagnosis of vulvodynia.
The patient was a 41-year-old female who came to PHRC with a five month history of constant vulvar pain described as red hot, itchy, and stinging. In addition, the patient had suprapubic and abdominal pain.
The patient’s pain increased with sitting, tight clothing, including underwear, exercise, and any kind of touch. As a result of the pain, sexual activity was not possible.
Upon interviewing the patient for her history, it was uncovered that: five months prior to the onset of her pain, she had had a vaginal culture taken that had tested positive for bacterial vaginosis. The infection had been treated with antibiotics; however, even after her follow up culture came back negative for infection, her symptoms continued.
In addition, the patient was involved in a motor vehicle accident four months prior to the onset of her pain, which resulted in TMJ pain that was being well-managed. The patient also suffered with migraines.
The medication the patient was taking was Sanctura, a medication used to treat an overactive bladder, nortriptyline, a tricyclic antidepressant that had been prescribed to her as treatment for her migraines, and a 5% lidocaine ointment for her vulvar pain.
The patient was receiving weekly acupuncture treatments and bi-monthly massages.
The patient was evaluated and treated by Liz, whose objective findings were:
- moderate to severe connective tissues restrictions along bony pelvis, medial to ischial tuberosities, and in suprapubic and abdominal tissue,
- moderate to severe pelvic floor muscle hypertonus,
- myofascial trigger points left greater than right bulbospongiosus,
- and poor pelvic floor motor control.
Liz’s treatment plan included:
- connective tissue manipulation,
- myofascial release per vagina,
- myofasical trigger point release,
- and a home exercise program of regular pelvic floor drops.
After four hour-long treatment sessions, the patient had no vaginal burning, no pain with sitting, and was able to wear pants without pain.
After five hour-long treatment sessions, she was able to have pain-free intercourse; however with some itching and burning afterward.
After six hour-long treatment sessions, she was able to have pain-free sex with no pain afterward.
After six weeks of treatment, Liz’s objective findings found an improvement in the patient’s connective tissue mobility; a minimum to moderate improvement in her pelvic floor muscle hypertonus; and a significant decrease in the trigger points in her bulbospongiosus muscles.
After six weeks of treatment, the patient believed she was having a relapse of the bacterial vaginosis. In addition, there was a significant increase in her stress levels. As a result, her symptoms flared for about three weeks.
After two appointments, the patient was again back to a symptom-free state. She continued PT every two to three weeks for three months until she was able to resume her regular exercises routine without vulvar irritation.
In total, she was released pain-free after 16 treatments with instructions to continue her home exercise program of pelvic floor drops.
We hope the information in this case study was helpful!
If you are a patient with vulvodynia or a PT that regularly treats the diagnosis, we’d love to hear about your experiences.
Thank you for reading and be well,
Liz and Stephanie