Treatment of PVD

 

Because PVD’s causes are not well understood, treatment has been developed by focusing on what works and discarding what doesn’t. For that reason, the outcome is generally considered poor. However, I have seen many women completely cured of PVD, and it is most certainly worth exploring treatment, even if it gives only partial relief.  The British Society for the Study of Vulval Disease encourages the practice of combining medication, physical therapy, psychotherapy, dietary changes and surgery, as the most effective way to tackle PVD pain, with the deployment of each one tailored to the individual case.

 

Most often, treatment starts by combining anti-depressants with ointment applied directly where the pain occurs, at the vestibule of the vagina. We then move on to a more active method of re-training the vagina to accept sexual stimulation and penetration.
Usually, a doctor will gradually increase the dose of anti-depressants, according to the individual patient’s needs, until the pain is under control. However, some patients abandon this medication because of its side effects, which can include, ironically, lowered sexual appetite. Other drugs are sometimes helpful for those who do not respond to anti-depressants, such as gabapentin, used to control seizures, and pregabalin, used to soothe pain in damaged nerves.

After the pain is under control, you will typically start with the first kind of physical treatment. This is minimally invasive, and involves gently rubbing creams containing corticosteroid or estrogen directly onto the entrance to the vagina to reduce inflammation, and to help reinforce the defense mechanisms of the vestibular mucosa. Estrogen supplements can also help, as a low level of estrogen - as mentioned above - is a trigger for PVD pain.

 

The vast majority of PVD patients also have chronic tension in the pelvic floor muscles, which adds discomfort to an already painful condition. This muscle tension is usually in response to pain, and can be treated with different types of physical therapy including external and internal massage, trigger-point pressure and biofeedback, all of which aim at desensitizing the pelvic floor area. Behavioral therapy is usually a good idea for PVD patients, as it works to relax the muscles and gradually ease the muscle tension. Kegel exercises, which involve rhythmic squeezing and releasing of the pelvic muscles, are easy for patients to learn simply by stopping the flow of urine mid-flow.  


The next phase involves using dilation-based “trainers”. These are small plastic cylinders of gradually increasing sizes, a bit like the tube that allows you to insert a tampon. They are used in gynecological surgery to stabilize the reconstruction of a vagina or the creation of a new vagina.

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