*First published in the June 2024 B.C. Centre for Vulvar Health Newsletter (Vancouver General Hospital)
It is important to acknowledge, up front, that doctors and patients may be sceptical about the role of psychology and the possible utility of psychological skills in helping them to manage vulvodynia. Some patients may have even seen doctors who have suggested that the pain is all “in their head” because there were no signs of injury or inflammation evident on a physical exam. However, it not true that if there are no physical signs that the pain does not exist.
What we know about pain is that there are always two components of pain. First are the unpleasant physical or bare sensations and second is the distress from those unpleasant physical sensations. When someone worries, catastrophizes, or becomes distressed in response to the pain, the physical pain becomes more intense.
Pain with vulvodynia is also unique because it has a direct impact on sexual health. Healthy sexuality is an integral component of quality of life, which influences general well-being, self-esteem, and relationship satisfaction. When pain from vulvar touch is present, this can significantly negatively impact a patient’s sexual health, mood and self-esteem, as well as romantic or sexual relationship. Moreover, sexuality remains a taboo topic, and reluctance to discuss sexuality or sexual problems is common among women and their care providers. With vulvodynia, many patients share stories of having seen several different care providers and having tried numerous different treatments, all with limited to no benefit. By the time they receive an accurate diagnosis and appropriate education about vulvodynia, many of these patients have experienced symptoms for many months or years.
This means that for many patients, initially there was “just” pain but over time came negative thoughts, feelings, and behaviours that resulted from pain which might include avoidance of sexual activity, low sexual self-esteem, frustration over the lack of information and support to treat vulvar pain and possible negative repercussions on the relationship. You can see how this initial “just pain” symptom evolves into a very complex, multifaceted issue. By the time patients with vulvar pain are seen in an appropriate treatment setting, there are often many emotional layers to unpack.
In terms of the role of psychological skills in navigating vulvar pain, our thoughts, or cognitions, and behaviours are strongly linked to our experience of distress. Reducing the distress around the vulvar pain, relationship and sexual impacts of pain, and mental health impacts of pain can ultimately lessen pain. This is why at the B.C. Centre for Vulvar Health, we emphasize a multidisciplinary approach which includes psychology in assessment and treatment planning.
Check out the B.C. Centre for Vulvar Health website for more information about the multidisciplinary assessment program at Vancouver General Hospital: https://www.bcvulvarhealth.ca/
