Treatment of Women in the United States with Localized, Provoked Vulvodynia: Practice Survey of Women's Health Physical Therapists

Objective: To identify current practice trends of physical therapists in the U.S. treating women with localized, provoked vulvodynia (LPV).

Study Design: The Section on Women's Health conducted an Internet poll in July of 2005 inquiring about physical therapy care of women diagnosed with LPV. It queried clinicians' demographics, physician/clinician referral patterns, assessment/ treatment modalities and length of care.

Results: Nearly two-thirds reported >11 years of physical therapy experience, with 42% treating women with vulvodynia for > 6 years. Most referrals were from obstetrician/gynecologists. Assessment modalities used by > 70% included detailed history; assessment of posture, tension in the pelvic floor, pelvic girdle, associated pelvic structures and bowel/bladder function; digital sEMG/pEMG testing of the pelvic floor; hip, sacroiliac joints and spine mobility; strength testing of abdominals and lower extremities; and voiding diaries. Nearly 70% utilized exercise for the pelvic girdle and pelvic floor; soft tissue mobilization/myofascial release of the pelvic girdle, pelvic floor and associated structures; joint mobilization/manipulation; bowel/bladder retraining and help with contact irritants, dietary changes and sexual function. Typical care is 60-minute weekly sessions for 7-15 weeks.

Conclusion: Sixty-three percent of physical therapists in the U.S. treating women with LPV have > 11 years of experience, with almost half treating women for > 6 years. Obstetrician/gynecologists are the largest referral source. Three quarters agree on 14 assessment tools, while more than two thirds agree on 11 treatments. Women are treated weekly for 1 hour, for 7-15 weeks.