How can you tell whether v is caused by a muscular problem or by nerves?

Just wondering whether anyone has any thoughts on this...Is there a way to tell whether my vulvodynia symptoms are caused by irritated nerves in the vulva area from a UTI/thrush  or by tight pelvic floor muscles etc Would be grateful for any ideas!

I've always thought it was a nerve issue with me so I stopped doing physical therapy, but now I've gotten much worse since stopping so I don't know what to think! I have constant burning down there 24/7. I can't wrap my head around this condition! I'm going back to physical therapy starting next week so I guess I'll see if that helps bring it back down from a 8/10 to a 5/10. I'll keep ya posted.

Misa1626 wrote:I've always thought it was a nerve issue with me so I stopped doing physical therapy, but now I've gotten much worse since stopping so I don't know what to think!  I have constant burning down there 24/7.  I can't wrap my head around this condition!  I'm going back to physical therapy starting next week so I guess I'll see if that helps bring it back down from a 8/10 to a 5/10.  I'll keep ya posted.

Thanks for taking the time to reply Misa1626. I'll be really fascinated to hear if the physical therapy has any effect on your V ie whether it improves the burning or not! I've been told that my V was caused by a  UTI or thrush aggravating the nerves, but I can't help wondering if a prolonged period of stress caused pelvic floor issues which impinge on the pudendal nerve and that in turn has caused the sore/raw burning feeling at the back of the vestibule... whatever, I just want to get better, wear my jeans and be able to sit down comfortably again...not too much to ask after 5 months surely!!

Joker, the best way to find out if its pelvic floor tightness is to get yourself referred to a women's health physio and ask for a biofeedback assessment. It involves having a vaginal probe inserted (ouch I know but worth it) and this takes a measure of your pelvic floor tone (they measure it as rest and also get you to do various types of contractions and relaxations). A normal PF tone is 2 or under - any higher and there is PF tightness.

A quick and unscientific method is to see how you feel in the mornings -if you wake up with no V pain but then find pain increases as you get up and move about during the day then its possible that its muscular (as your muscles will have relaxed during sleep but then tense up again once your awake and up). Presume you've had all the tests to rule out UTI/thrush?

And i agree, i think stress can be a factor in tight PF. Mine started after a stressful period and i later found out that I had been clenching my butt and abdominal muscles constantly without even realising it!

Misa, physical therapy (in any format) is a long road unfortunately - took me over a year. I think of it as muscles have memory and they have to be retrained.

Good luck ladies. let us know how you get on.

The Joker, I am wondering the exact same thing about my own vulvodynia. I have initially always assumed mine is more in the skin because of the type of pain that it is, but recently I just don't know anymore. When I press down on the sore areas they almost ache, so I don't know if it could in fact be muscular. Or could it be two things going on at once? Or nerves just being messed up and feeling pain when there isn't any. I can only speculate. My plan is to see a vulvar dermatologist and a gynaecological physiotherapist to sort this shit out. Someone just fix us, please ! Hope I offered you some support x

Thanks for your support Tinkerbelle 2 and Loulou! It's nice to get some expertise and thoughts from other people. I don't wake up with any pain any more at all, it creeps up during the day which I guess points in the direction of pfd/muscular issues. Bring on the Womens Health physio...

Good luck with the vulvar dermatologist and  gynaecological physiotherapist Tinkerbelle2, I hope they can help you to help your body heal..

Mine is muscular /pfd related & I do get no pain in the mornings and then get worse as the day goes on. At first I thought it was nerves but tight muscles can irritate the nerves and cause pain. So it can be difficult to tell. My pain then spread into my legs which I couldn't relax at all and back & hips which all pointed to muscular.
What is helping me is notriptyline for the v pain & physio to ease my muscles. I do pilates exercises & pelvic floor stretches every day too. My pain levels have dropped and I'm managing now to take 5mg of notriptyline every other day (to start with I was on 10-20mg a day). I not out of the woods yet but I am much better than I was a year ago. I agree that stress plays a part too because when I get stressed I can literally feel all my muscles tightening up.

I'd say it's worth seeing a physio who specialises in pelvic pain to get checked out.
Good luck....

Thank you, I hope you do too sweetie! If you don't wake up with pain it definitely sounds like the women's health physio could be helpful! Good luck and keep us posted

Hi Guys, so I went to physical therapy and decided to ask her what she thought. She said that she thinks it's a bit of a vicious cycle, like you said Kathy. It may start with thrush or a UTI that gets the nerves out of whack but that in turn can cause muscle spasms which then end up causing more pain! I'm hoping I can calm the nerves with amitriptyline and Celebrex which I'm about to start tonight and retrain my muscles with physical therapy. Gotta keep positive. Eyes on the prize. I'm going to get better. In the mean time glad I have the support of you all!!

Hi Misa, that's a really interesting thought on how things could be linked like that. I have a dermatology appointment coming up and it's worth me having a physio one as well I reckon. Thinking of all you girls!