His and Her Health

Hi Niva

I have been diagnosed with Vestibulodynia. My question is this. My doctor told me that normally initially it is a neurological issue that snowballs into pelvic muscle spasms that pinch the nerve endings causing a pain cycle.
What nerve endings does she mean- the pudendal nerve- is that the only nerve that innervates the vestibule?

ty

Also, have any of your patients had less pain at the vestibule by having nerve blocks or botox done?

thanks!

DanielleBAN,
I'm not a doctor, but I know from personal experience that vestibulodynia (pain in the vestibule) does not necessarily lead to pelvic muscle spasms. pelvic floor dysfunction can lead to pain in the vestibule but I know that vestibular pain doesnt necessarily lead to pelvic muscle spasms.

And it depends on what's causing your vestibulodynia too. Saying that vestibulodynia is always a neurological issue seems a bit broad. Obviously pain is caused by nerves, but vestibulodynia can be caused by many other factors too. Dr. Goldstein talks about all the different factors that can lead to pain on his website www.ourgyn.com such as skin disorders and what not.

So if you have been diagnosed with vestibulodynia, don't assume you are automatically going to get pelvic muscle spasms (unless you already have them).

<small>[ 05-13-2009, 04:44 PM: Message edited by: Moderator ]</small>

I was told my muscles are hypertonic, but wanted to ask Niva if she has had any patients experience relief from botox or nerve blocks on the outside area that burns when I touch it

DanielleBan, I think I have seen patients better off w/botox combined w/PT more than w/ nerve blocks.

Niva

the patients you treat that have vestibulodynia that had the botox done, did the pain on the outside (vestibule) go away or decrease with the botox?

ty

From my memory, reduced pain yes and some gone completely. but remember, my patients are not botox ALONE; they are also doing PT once a week (sometimes twice) and home exercise programs!

Niva, my doctor told me that the pain that I am experiencing at the outside of my vestibule is due to PFD. Can you explain the process for me?
Is that muscles compressing nerves that cause the pain there? If so what nerve?

thank you

DanielleBAN, I am not sure where you are referring to as "outside" the vestibule.
When there are restrictions in the connective, myofascial, soft tissue, it allows for less or little movement. This restriction could be affecting the nerve. Also, circulation, meaning oxygen are also lessened to the area, so then the tissue continues to be in poor quality. This too can lead to discomfort. Most likely the branches of the pudendal nerve are affected, but if pain is throughouth the vulva, then other nerves too can be affected.

Hi Niva

No pain in vulva, just vestibule at bottom.
How do you address the restrictions you speak of above?

ty

DanielleBAN, I use manual therapy techniques and nerve mobilizations to release them along with patient education and home exercise program.

Niva what are nerve mobilizations?

This is a type of technique which allows you to move a nerve through the surrounding tissue.