Patient Story: Vulvodynia – Pain and Burning at the Entrance to the Vagina (“Vulvodynia”) Caused by Back Ligament Looseness

There are many causes of “vulvodynia”, including skin conditions. The type we are describing is associated with low abdominal pain, urgency, nocturia and abnormal bladder emptying.

Mrs P was 49 years old. She had chronic pelvic pain and she requested referral to the clinic because she had heard that we were achieving good results in patients with pelvic pain. 

Her General Practitioner, an empathetic and caring man, rang the doctor before she arrived and asked that we “handle her very carefully” as she was severely disturbed psychologically, that this was the reason for her pain and there was nothing anyone could do for her. The first impression we had of this lady did indeed fit the description of her GP. Her face was contorted, she spoke rapidly and with obvious anxiety. She had visited many specialists over the years for her pain. She had undergone several diagnostic laparoscopies (a type of telescope inserted into the abdomen to view the uterus and ovaries), even a hysterectomy and had attended a pain clinic. None of these treatments had helped her pain. The consensus from other specialists as reported to the GP was that herproblem was psychological. 

Her replies to the questionnaire gave the first hint that this woman may have a physical cause for her problem, damage to her back ligaments. She woke 6 times per night to empty her bladder (nocturia), wore pads continually as she wet 6 times per day (urge incontinence) and had difficulties emptying her bladder. She also had faecal incontinence. We asked her if she had told her GP about her bladder and bowel problems. She said she had only consulted him about the burning pain around her vagina and anus. She said that her vagina was so tender that she couldn’t have sexual intercourse and sometimes had problems sitting. 

Examination revealed a prolapse of the back part of her vagina. The entrance to the vagina was hypersensitiveshe recoiled when gently tested with a cotton bud, the classical test for “vulvodynia” (pain at the entrance of the vagina). 

We did not claim that we could cure this lady’s pain, as there are many other causes for pelvic pain.

Nevertheless, it was explained that her vaginal prolapse needed to be fixed and that there was a strong possibility that some of her symptoms would also improve with a sling inserted into the back part of her vagina, a fairly minor day-care procedure. 

The first thing we noticed at the 6 week post-operative visit was the absence of tension in her face.

She was smiling and calm. Her pain was gone, as was her urgency and faecal incontinence. Her nocturia had reduced to 2 per night and her bladder emptying was “60% improved”.

Like the case of Mrs D, this lady’s problem raises many issues about the attitudes of doctors, patients, even modern medicine itself. Many doctors, including this lady’s General Practitioner, were not aware that this type of pelvic pain is associated with loose ligaments. Because of the scientific nature of medicine, if an obvious cause cannot be found, the doctor seeks another cause, usually “psychological”.