Vulvodynia vs. Vaginismus: Doctor Explains the Differences

A doctor who specializes in chronic pelvic, genital and sexual pain disorders describes the differences between vulvodynia and vaginismus, terms that are commonly used interchangeably.

Is it vulvodynia?
Is it vaginismus?
Is there a difference between vulvodynia and vaginismus?

Yes!

“These two conditions are all too commonly confused with one another,” says Robert J. Echenberg, MD, founder of The Echenberg Institute for Pelvic & Sexual Pain, and co-author of “Secret Suffering: How Women’s Sexual and Pelvic Pain Affects Their Relationships.”

Vulvodynia Symptoms vs. Vaginismus in Day to Day Living

“Dynia means pain, so vulvodynia means pain in the genital region of the female – the ‘saddle area’ between the inner thighs and extending from the clitoris back to the tailbone,” explains Dr. Echenberg.

“Because this area of the body is so private and has so much social stigma and secretiveness, there remains continuing confusion about the many conditions that may contribute to painful sensation with sitting and a variety of daily bodily functions such as urination, defecation and especially penetrative vaginal activities as in sexual intimacy, use of vaginal tampons and even tolerating inspection for a routine Pap smear,” continues Dr. Echenberg.

“Vaginismus, on the other hand, refers to an involuntary tightening or clenching of the pelvic floor muscles – especially the ‘Kegel’ muscles at the base of the entire pelvic floor.

“In the case of vaginismus, there does not need to be an accompanying painful condition causing that tightening – but can be secondary to any reminder or memory of previous actual or perceived trauma or pain in the pelvic region.

“In these cases, the pelvic floor muscles can be so tight as to cause a great deal of pressure sensation and the uncomfortable pressure feeling of something ‘filling or falling out’ of the vaginal or rectal region.

“Vulvodynia always causes variable degrees of muscular spasm or clenching as well, which is the body’s natural protective mechanism to fend off any further threat of touch or actual painful penetrative activity”.

Dr. Echenberg has found in his many years of caring for these conditions that the best term for muscular spasm, secondary to a physical pain condition, should be hypertonic pelvic floor dysfunction, and not “vaginismus.”

Hypersensitivity: Subset of Vulvodynia

A patient may have both vaginismus (HPFD) and vulvodynia – and the latter may be a subset rather than all-out vulvodynia.

This subset “is when the tissue between the vaginal lining and the outside hair-bearing skin on the genital area, the delicate skin inside the inner lips of the labia, becomes sensitive to even slight touch such as the gentle application of a Q-tip to the area,” explains Dr. Echenberg.

A patient might describe this as overly sensitive nerve endings – even when she is merely removing bits of tissue paper that have broken off from a previous wiping after urination.

Dr. Echenberg continues, “This location is known as the ‘vulvar vestibule.’ and when this area is highly inflamed and sensitized, the term used is vestibulodynia or vestibulitis.

“This subset of vulvodynia is the most common reason for entrance pain in reproductive age women.”

Common Descriptors

Dr. Echenberg notes that the following descriptors by patients are common with vestibule inflammation and sensitivity.

Dryness
Irritation
Burning
Stabbing
Ripping, tearing
Hot poker
Ground glass
Sandpaper

“There are many theories about the cause of such severe localized pain, but most research is indicating that excessive ‘aggravation’ and sensitivity of the nerve endings in that skin at the vaginal opening is the underlying problem.”

Dr. Echenberg explains that in those women who suffer with vulvodynia and/or vestibulodynia, “The muscles are reacting to painful stimuli arising from any number of possible generators of pain in the pelvic and genital region.

“These muscles are tightening because of perceived need to stabilize and ‘splint’ the pelvic region, just as all the muscles in the arm and neck will spasm and protect against movement of the arm when there is a shoulder separation or other injury.

“Eventually, this clenching becomes persistent and difficult to ‘loosen up’ – just as in the condition of ‘frozen shoulder.’”

In short, Dr. Echenberg acknowledges that there is understandable confusion between the terms vulvodynia and vaginismus, but he reminds us that the experience of the woman may be the same in both.

“Pelvic muscle tightening – whether secondary to an ongoing pelvic pain disorder such as painful bladder syndrome/interstitial cystitis, irritable bowel syndrome, endometriosis, pelvic neuropathies, etc., (pelvic floor dysfunction) – or whether from long term fear or anticipation of pain (vaginismus), the result can severely limit the normal function of the genital area.”

Vulvodynia and Vaginismus Myths

The two big myths are that these disorders are “all in a woman’s head” or are always the result of past sexual abuse or assault.

These myths are not grounded in reality. For example, a virgin who’s never even been fondled can still have vaginismus (hypertonic pelvic floor dysfunction) or vulvodynia.

A 14-year-old virgin may accidentally discover she has either of these conditions when first attempting insertion of a tampon (though will very likely not know her situation has a medical name).

Remember, it’s that anticipation and fear of penetration – even though it’s self-penetration – that induces the muscles to spasm. She cannot relax them like she can relax a flexed bicep.

“Because many gynecologists and other specialists are not currently trained or familiar with pelvic and genital pain conditions, they often fall back on the old assumption that most of these young women must have suffered previous sexual abuse,” says Dr. Echenberg.

He gives examples of many of his young patients having been athletes with such sports as gymnastics, soccer, softball and even years of dance, who have never been abused but who have had multiple cumulative injuries in the “saddle” region – resulting in long term traumas – long since healed – leading to these disorders.

It’s also possible for a patient’s negative anticipation of penetration to have no known etiology.

“Neuropathic and muscular ‘memory’ will then trigger involuntary clenching,” and Dr. Echenberg says that “it is not clinically important whether neuromuscular spasm is called vaginismus, vulvodynia or pelvic floor dysfunction.

“The treatment approaches will all be similar and will almost always involve a pelvic floor physical therapist to help ‘retrain and reboot’ the brain/body connection.”