081 Patient Techniques Aimed at Easing Chronic Vulvar Pain Prior to Internal Assessment

Reducing abnormal tension in pelvic floor muscles (PFMs) in women with vulvar vestibulitis (provoked vestibulodynPVD) was found by Glazer in 1995 to improve sexual function and decrease complaints of chronic vulvar pain. Multiple studies since have confirmed the presence of abnormal tension in PFMs in women with PVD when compared to matched, asymptomatic controls. Though its pathophysiology remains unclear, PVD may be caused by inciting events in patients’ histories. Histories that includes recurrent yeast or bacterial infections, urinary or bladder infections, endometriosis, or chronic bowel dysfunction can have a lasting, negative impact, causing PFM dysfunction as well as elevated tension in the affected viscera. Though this may not occur in all, many women with PVD present with both elevated PFM tone and residual abnormal visceral tension. Though PFM dysfunction appears to be a primary driver of chronic vulvar pain, it is possible that the muscular dysfunction is secondary to abnormal tension in the surrounding abdominal and pelvic viscera, fascia, and muscle. Together, these abnormal physical findings make internal assessment, whether digital or with a speculum, painful, difficult at best, or often impossible.