October 2020
Vulvar pain affects up to 20% of women at some point in their lives, and most women with vulvar pain have associated pelvic floor impairments. In her paper published in Obstetrics and Gynecology Clinics of North America, Stephanie Prendergast, MPT, provides a clinician's guide to pelvic floor dysfunction, and how these conditions are associated with significant functional limitations in women by causing painful intercourse and urinary, bowel, and sexual dysfunction.
Stephanie Prendergast is Director of Pelvic Health and Rehabilitation Center (PHRC), a physical therapy practice that focuses solely on the treatment of pelvic pain/dysfunction for men and women.
Stephanie is a well-recognized expert and thought leader in the treatment of pelvic pain/dysfunction. She lectures worldwide and has been interviewed and/or contributed articles to publications such as the New York Times and The Los Angeles Times along with several medical textbooks, including Chronic Pelvic Pain and Dysfunction: Practical Physical Medicine published by Churchill Livingstone.
Her book Pelvic Pain Explained: What You Need to Know, written with PHRC co-founder Elizabeth Rummer, explores how patients develop pelvic pain, the challenges patients and providers face throughout the diagnosis and treatment process, and more.
SHWI: As a nationally known physical therapist (PT) focusing on pelvic floor health, how do you believe physical therapy impacts the health of the vaginal biome?
I am not aware of research specifically studying the effect of pelvic floor physical therapy on the vaginal biome. However, I would think that the lubricants women use both with transvaginal pelvic floor PT, gynecologic exams, and sexual activity may have an impact on the vaginal biome and should be considered when choosing products for these uses. Pelvic floor physical therapy addresses somatic and nervous system structures to help eliminate pain and improve urinary, bowel, and sexual functioning.
SHWI: In your published paper, you provided a clarification on definitions of common vaginal disorders. Can you explain why this clarification is so important?
The term “vulvodynia” simply means pain in the vulva. It is more of a symptom descriptor than a diagnosis. It is important to know why a woman has vulvar pain in order to be able to effectively treat the problem.
In 2015, multiple societies that focus on women’s sexual health held a nomenclature consensus conference to review the evidence on vulvodynia. Prior to this meeting, vulvodynia was being described as “pain in the vulva of unknown cause persisting at least three months with no known cure.” This was a devastating diagnosis for suffering patients. The previous definition did not reflect what we know: vulvodynia is a pelvic pain syndrome with nine known causes and multiple associated factors. It is a treatable condition.
I was honored to be part of this meeting and, as a result, the International Pelvic Pain Society, The International Society for the Study of Woman’s Sexual Health, The International Society for the Study of Vulvovaginal Diseases, The American College of Obstetrics and Gynecology, and the National Vulvodynia Association all agreed on the new terminology. This is improving the treatment landscape for women with vulvar pain.
Vulvodynia is not a mystery to people who specialize in pelvic pain; however, the majority of general gynecologists and primary care physicians may not be aware of the literature. So, we still have a lot of work to do around education and helping women get diagnosed faster.
SHWI: Many gynecologists say that the best treatment plan includes a collaboration with a physical therapist to treat complex vaginal disorders. Can you explain the critical aspects of a therapeutic relationship between patient, physician, and PT?
This is a wonderful point and something that can be optimized with some effort on all involved. Pelvic floor disorders often involve multiple systems – not just the musculoskeletal and nervous system which is what we as pelvic floor PTs can treat. More often than not our patients are also dealing with hormonal insufficiencies, vaginal and bladder infections, and other diseases such as endometriosis or IBS/SIBO. As pelvic floor PTs, we often have the most time with the patient and must be aware of overlapping issues that can affect their treatment plan. At our company we take on the role of “case manager” to help our patients coordinate their care.
SHWI: If you could standardize pelvic floor care for all women patients, what would you prescribe to maintain a healthy pelvic floor? And why is this important to your vaginal health?
All women who have given birth should see a pelvic floor PT, regardless of when they delivered. All perimenopausal women can also benefit as our pelvic floor muscles weaken as our estrogen declines.
Sex should never hurt; we should not leak urine or have pain urinating; bowel movements should be easy and comfortable; and our pelvic organs should not be in our vaginas. A recent study showed over 95% of people with lower back pain also had pelvic floor dysfunction. Women can benefit from seeing a pelvic floor physical therapist at certain milestones in her life or if they are experiencing any of the above symptoms, including low back pain.