Pelvic Floor Therapy for Provoked Vulvar Pain: What the Trial Included

A referral for pelvic floor therapy can leave several practical questions unanswered: how often you will attend, whether treatment involves an examination, and what you will practise at home. For provoked vestibulodynia, one influential trial gives a specific example of the care being studied.

What the ten-week program contained

The 2021 Canadian trial¹ randomized 212 women to physiotherapy or overnight 5% lidocaine ointment for ten weeks. Therapy involved weekly, individual, one-hour appointments with specially trained physiotherapists. Its components were education, manual treatment, pelvic floor exercises with biofeedback, and dilation, plus home practice.¹

Cambridge University Hospitals’ patient guidance also emphasizes learning to relax the pelvic floor as well as contract it. Its assessment considers movement and contributing structures, with external and sometimes internal examination. The hospital describes relaxation and breathing among its treatment approaches.²

Before accepting a referral, ask the service to explain its assessment and treatment options. Clarify which examinations or techniques would involve vaginal contact and discuss your preferences before agreeing. Ask how the therapist changes a plan when an exercise provokes pain.

What improved, and how much

After treatment, average intercourse-pain scores favored physiotherapy by 1.8 points on a 0–10 scale; the between-group difference was also 1.8 at six months. After treatment, 79% receiving therapy reported being much or very much improved, versus 39% receiving lidocaine. These are improvement rates, not cure rates.¹

SBU’s 2021 systematic assessment rated evidence favoring multimodal physiotherapy over lidocaine as low certainty. It noted that many interventions had only one small or medium-sized study, limiting firm conclusions. Its assessment supports discussing this option while keeping uncertainty about the size and consistency of benefit.³

Who the trial enrolled

Eligibility required women aged 18–45 who had not given birth, with diagnosed provoked vestibulodynia and intercourse pain lasting over six months. Other conditions, including deep pain during sex, were excluded. Participants knew their treatment, and there was no placebo arm.¹

Someone with new pain after menopause, deep pelvic pain, or a different examination finding needs an assessment suited to that presentation. A trial’s eligibility checklist cannot diagnose the cause of your pain.

Questions that make a referral more useful

Bring these to the appointment or ask the service before booking:

• Who will assess me, and what experience do they have treating vulvar pain?
• How many visits are proposed, what does each cost, and what is available while I wait?
• What home practice would you suggest for my findings, and when should I pause and contact you?
• When will we review progress, and what would prompt reassessment of the diagnosis?

Agree on the activities you want to make more comfortable, such as sitting, using a tampon or intimacy. Discuss a way to track progress that does not require attempting painful penetration.

Down There, Decoded covers “When Sex Hurts” and a See script for recording pain location, triggers and how long it lingers. Those notes can help you explain why you are seeking a pelvic floor assessment.