Is there a key to understand vulvar and sexual pain?

Here's how Prof. Graziottin answers this question from her patients:

To understand vulvar and sexual pain we must consider the importance of pelvic floor muscles. Look at me, imagine that my arms are the pelvic floor muscles like a double-edged door. If they are very tightened, they’re contracted and retracted, and they squeeze the entrance of the vagina (imagine my body is the vagina) and this will make penetration impossible. 

This is what happens in the serious severe vaginismus.

If the muscles are tightened but not that tightened, they allow penetration but this will cause “microabrasions” at the entrance of the vagina with key changes in the microbiome in the area (dysbiosis) and this will facilitate candida attack and an aberrant immunitary reaction to the candida. So you have all the symptoms of the candida infection, yet you cannot detect it with a sample in the vagina.

And more importantly, we have a change in the anatomy of pain fibers, and this is responsible for the burning pain you have at intercourse, during intercourse, and after intercourse. And this is the key symptom we define as “provoked vestibulodynia”, which is part of the vulvodynia.

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