Hi all! Welcome to November and the fourth email of this new series about the little things you can do for common issues at home.

I got back to Alaska from Hawaii at the beginning of the week, and I went from tropical weather to snow and below freezing. I'm still adjusting, but trying to see the beauty of the winter....(mostly just missing the heat and ocean though). Here's a photo from the trip!

Today we're talking about vulvodynia, vaginismus, vestibulodynia, and dyspareunia. So fun, right? This will be an overview designed to help jumpstart your research. While two of these words don't include "dynia" they are included because they are definitely related.

You've probably realized by now that nothing is really TMI in my world, and too many people suffer in silence. So let's talk about it. Of course always please chat with your provider if you are concerned, and know that this list is not medical advice. :)

Let's go through each word and define it.

Vulvodynia: pain in the vulva. This is a more general term to describe any type of pain in the vulvar area. This is a "blanket" diagnosis, so to speak. Once you identify more specific aspects to your pain, you can figure out the root.

Vestibulodynia: pain in the vestibule, the entrance to the vagina. Often this presents as burning pain from 3 to 9 o'clock, if you view the pelvic floor as a clock, with 6 being at the tailbone. This pain is complex, and very specific, resulting in pain with initial penetration, and often causing discomfort with sitting, tight pants, biking, horseback riding and other similar activities. There are several types of vestibulodynia, depending on if you were born with too many nerve endings in your vestibule (would always have pain) or if it's something else that provoked it (pain after a specific time like a yeast infection, sexual trauma, etc.) New research is coming out saying that MCAS, mast cell activation syndrome, is a player in this condition, suggesting that those with vestibulodynia have a significant amount of mast cells in the vestibular tissue compared to surrounding tissue and vestibular tissue of those who don't.

Dyspareunia: painful sex. This is also more of a blanket term, and you'd want to ask yourself more questions (listed below) to be able to tell your provider to help narrow down the cause of the pain and be as specific as possible in treatment! Could be related to post-birth healing, vaginismus, either or both vulvodynia and vestibulodynia, past sexual trauma, or a number of other factors.

Vaginismus: involuntary tightening of the vaginal muscles, preventing or limiting penetration. This can be a result of sexual trauma, birth trauma, religious upbringing, or simply excess tension in the pelvic floor potentially due to hypermobility. This oftentimes goes hand in hand with vulvodynia, vestibulodynia, and dyspareunia. Yes, you can have all of these at one time. Wild, right?

How do I narrow down my pain?

Here are some great questions to think about and answer when you're experiencing pain in your pelvic floor:

• When do I experience the pain? Is it only with penetration? Is it with initial penetration, deeper penetration, no penetration at all? Is it with light touch? When sitting on a hard surface, sitting for longer amounts of time? Only with orgasm? Only with arousal? Only during exercise or after exercise? Certain exercises? Is it with long periods of standing or walking?
• What type of pain is it? Burning, stabbing, achy, dull, pin pointed, delayed, throbbing, shooting, cramping, tender, heavy, raw, searing, electric, radiating, mild, moderate, severe, excruciating. Maybe it's dull when walking, but searing with penetration? Take note of everything.
• Where is the pain? Generalized vulvar area? What "number on the clock" is it? Does the area change based on activity, or where you are in your cycle? Can you pin point the location, or does it feel like it radiates so much you can't put a finger on it?

All of these questions and definitions should help you narrow down what you're feeling, and give you a great starting place when talking to your provider, which I 100% recommend you do. I also recommend talking to a therapist or someone you trust about the pain, because pelvic pain wreaks havoc on mental health, and oftentimes when one is bad, the other follows suit and we need a multi-factorial approach to getting both better.

For specifics on subcategories of Vestibulodynia, see this flowchart to help you communicate this with your provider.

For more information on vulvar pain in general, anatomical illustrations, and research, and resources for both individuals and providers, visit the National Vulvodynia Association.

What can we do from home about pelvic pain?

• Educate yourself: this is the single most powerful thing you can do. Once you know and understand more about pelvic pain, the more options you have and the better you can advocate for yourself!

• Communicate: talk about it. So many people suffer in silence, and wait years before asking for help. Chances are there's someone else you know with pelvic pain and you're both not talking about it because you think you're alone. Talk to someone you trust, and definitely journal about it, so you can organize your thoughts and feelings.

• Don’t be afraid to say no to sex while you heal. This is crucial for the pain feedback loop in our brains. If you just suck it up and endure the pain, it creates more groundwork for sex to always be painful. The good news is that you can rewire your brain! This often comes with therapy, both physical and emotional, and time. Don’t underestimate the time it will take.

• Find things that bring you joy: Take some time for yourself where you can have fun and relieve some stress. Pelvic pain can be all consuming, believe me, I know! It's important to take a step back sometimes and focus on something else for our mental health, stress management, and overall wellbeing.

• Get a referral for pelvic physical therapy: Okay I know this isn't a home treatment, but it's something that needs to be included. Pelvic PT can make a significant difference in how your body reacts to the pain. A great therapist will help you do the exercise you want to do while giving your strategies to help mitigate pain, and get back to life and hopefully find a long-term solution for your pain!

• Know these "diagnoses" are not your fault in any way. Sometimes our bodies respond to stimuli and input in this way, and some people are just more predisposed to having pelvic pain than others.

• Take some deep breaths and work on relaxing your pelvic floor muscles: Read this great blog post with some practical stretches you can do today: Tips for Pelvic Floor Relaxation by Pelvic Guru

A couple products that might be helpful:

• Desert Harvest Reléveum: contains aloe and 4% lidocaine which can help with burning pain and pain with penetration. Currently looks like it's on backorder, but will hopefully be in stock this month.
• Anything Butt hemp balm: good for vulvar sensitivity and dryness (and literally everything else, like a sun rash that you get from being in Hawaii), not just for booties! That link gets you 10% off.
• Not a specific product, but switch to cotton underwear for breathability and avoiding microplastics near your absorbent bits. Ditch the polyester for more reasons than just pelvic floor sensitivity (and have any guys in your life do the same - studies show sperm/fertility is impacted by plastic undies.) I like Pact brand.

Hopefully this was informative and helpful to you on your journey, or gives you the resources to help others who might be suffering.

As always, I am happy to talk to anyone about this more specifically. Reach out if you need. 💛

Warmly,

Natalie