Vaginal & Anal Pain (Pudendal Neuralgia, Vulvodynia/Vestibulitis)

Vaginal and anal pain can be debilitating and interfere with many aspects of life. Pudendal neuralgia, vulvodynia and vestibulitis are three examples of medical diagnoses that may cause vaginal and/or anal pain. Pudendal neuralgia is irritation of the nerve that stems from the sacrum, or large triangular bone at the base of your spine. This nerve has sensory and motor duties in relation to the bladder, anus, and pelvic floor muscles. Vulvodynia is characterized by a burning, rawness, irritation, and/or knifelike pain throughout the vulva or opening of the vagina with any type of touch or attempt of insertion.


Pudendal Neuralgia:
– Pain in saddle region with sitting or wearing tight clothing
– Pain with sex
– Bladder and/or bowel problems,
– Pain or spasm post orgasm
– Pelvic floor muscles spasms
– Odd sensations including burning, itching, and coolness which may extend to the abdomen, buttocks, groin, and/or legs
– Relief or no pain with standing or sitting on the toilet

– Burning, rawness, irritation, and/or knifelike pain throughout the vulva or opening of the vagina to touch or insertion.
– Symptoms can be intermittent or chronic.


Direct causes of vulvodynia or vestibulitis are unknown, but it is theorized that the symptoms stem from nerve pain. Pudendal neuralgia is defined as irritation of the pudendal nerve. If you were to sit on a bicycle seat, the area where you feel the seat is where the pudendal nerve runs on each side. The pudendal nerve can be irritated by being compressed by surrounding muscles, surgery, childbirth, or trauma.


Your physical therapist will perform a thorough evaluation to assess your symptoms. Being the evaluation will be internal and external, you and your therapist will work together to ensure your comfort throughout the entire process. Any of the above diagnoses can create significant pelvic pain, pelvic floor muscle dysfunction, pelvic floor muscle spasms, and even musculoskeletal pain. Your therapist will assess all related musculature, both internal and external, alignment, and strength. If your therapist feels you may need further examination or testing, she will refer you to an MD.


Treatment for vaginal and/or anal pain will depend on your presentation. Your therapist is also an orthopedic trained physical therapist who will be able to target treatment to the overlap of orthopedic and pelvic floor symptoms, with a focus on the actual cause. She will address both the pelvic floor and musculoskeletal pain through manual and therapeutic exercise, as needed. Your therapist and you will also discuss home exercises and strategies to reduce your symptoms.

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