Vulvar vestibulitis is a type of chronic pelvic pain associated with dyspareunia, intolerance of localized palpation or pressure in the area of the vulvar vestibule, and varying degrees of erythema. The purpose of this case report is to describe the physical therapy interventions successfully employed to manage a patient who was diagnosed with vulvar vestibulitis.
This is a case report of a 25-year-old female, with no prior history of sexual activity, whose chief complaint was a 3-year history of severe pain (8/10) associated with routine gynecological exams and whose secondary complaints were of perineal swelling and intermittent soreness and itching in the area of the vulvar vestibule. The individual's insurance provider had initially denied the physical therapy plan of care but then subsequently approved 6 visits after appeal.
Pain was elicited with external palpation over the levator ani musculature, and pain and increased tone were noted with internal palpation at the introitus and over the coccygeus and levator ani musculature. Digital testing revealed pelvic floor strength of 0/5.
Following 8 physical therapy sessions, which included electromyography (EMG)-assisted pelvic muscle relaxation and strengthening, as well as intravaginal soft tissue mobilization, the patient reported pain of 0/10 with palpation and of 0.5/10 during a subsequent routine gynecological exam. The perceived severity of the problem decreased from 5/10 to 0/10, and digital pelvic muscle strength increased from 0/5 to 3/5.
Discussion and Conclusion:
Vulvar vestibulitis is commonly diagnosed following complaints of severe pain with vaginal entry, localized tenderness, and varying degrees of erythema at the vaginal vestibule. Since this patient had no history of sexual activity, the diagnosis was primarily based on complaints of severe pain during routine gynecological examinations. Physical therapy interventions, consisting of relaxation and strengthening of the pelvic floor musculature and soft tissue mobilization, successfully eliminated symptoms and restored functional strength. Persistence in following up with the insurance provider allowed for coverage of treatment which was initially denied.