Vulvodynia affects about 8-10% of the female population, ranging from all ages, and is defined by the pain of the vulva tissue. The cause of this pain is seen in the traditional medical module to include the nervous system, pelvic floor muscle dysfunction, as well as an emotional component. Treatment usually entails pelvic floor Physical Therapy, pharmaceutical treatment, cognitive behavioral therapy, and surgery as a last resort. A functional medicine approach also recognizes the gut impact on not only the tissue in the pelvic floor region but also on the nervous system.
[signup]
CC: Bilateral Foot Pain, Neck Pain, and Vulvodynia
Sally was a 50-year-old female presenting with bilateral foot pain, neck pain, and vulvodynia. She was already working with another physical therapist for her neck, and her main goal with our sessions was to help decrease her bilateral foot pain, which she believed to be due to plantar fasciitis that she had been experiencing for 10 years. She wore night splints for the last 5 years and could not tolerate standing for long periods of time with shoes or barefoot. The shoes she was in had a lot of cushion, and she wore orthotics to help decrease her foot pain.
For her vulvodynia, she was prescribed estradiol and had done pelvic floor physical therapy before. She noted she still continues to have pain, with the most pain while sitting. Unfortunately, for work, she needed to sit to work with her students for long periods of time in chairs made for toddlers, which put a high amount of stress on the pelvic floor area. A few years prior to her vulvodynia diagnosis, she was diagnosed with vaginosis.
Additional History:
As to her mental health, she noted a very stressful job that required medication to help her with her stress. She also noted a past traumatic experience.
For important surgeries pertaining to her feet, she had two to remove a spur at the end of her first toe, which had come back again recently. Her doctor recommended a third surgery to remove the spur, but this time, they would add something to the end of the bone to prevent the regrowth. She has decided to hold off and see if she can get to the root of why the spur comes back.
She has been a vegetarian since 1990. Her digestive history consisted of bloating of the whole abdomen, bloating after meals, constipation, and an intolerance to gluten and fatty foods. In her candida questionnaire, she came to a grand total of 242, which, according to the IFM outline, the "yeast-connected health problems are almost certainly present."
Lab Work
The following initial test was ordered:
Organic Acids Test (OAT) Results (Mosaic Diagnostics - Formerly Great Plains Laboratory)
Organic Acids Test Analysis
Yeast and Fungal Markers: Her testing noted high markers, which suggested she was positive for fungal overgrowth within her intestines.
Bacterial Markers: She had high markers on 2 of her GI bacteria (Hydroxybenzoic and Hydroxyhippuric), which was indicative of dysbiosis in the gut, specifically small intestine bacterial overgrowth (SIBO).
Oxalate Metabolites: Her numbers for oxalic came in high. This sample was taken from urine, and it is noted if this is high, it can cause vulvar pain in women. This number could be elevated due to diet since oxalates are high in fruits and vegetables, but could also be elevated from candida (yeast overgrowth).
Interventions
In order to work on her foundation and address her feet, we worked through some exercises to help relax and mobilize the foot. This included a foot release with holding a ball on specific spots for 20 seconds 2 times a day. We added backward walking to slowly load the plantar fascia in an elongated state to help the tissue heal and mobilize appropriately. The next step was helping get her into a shoe that was ideal for her foot type but slowly worked into something with some mobility and less cushion. Since she was in such a chronic pain state, we also addressed some nervous system regulation with breathing to help with pelvic floor mobility as well. The feet are so important to support the whole body, but they also affect the pelvic floor through fascial ties, and addressing the feet can impact the pelvic floor tension.
On top of breathing, we also added dilator training, pelvic floor relaxation, and pelvic floor activation in different positions. This was meant to help bring better blood flow to the tissue and help decrease some of the tension that was causing the pain. Once we discovered she had more gut dysbiosis, we switched gears to focus treatment on healing the gut to help calm the systemic inflammation she was experiencing.
An herbal supplement protocol was started to address the gut and was completed in 3 phases. Herbal supplements were through WEI laboratories. She completed 3 phases since she was taking half doses to assist her gut in healing.
Herbal Protocol:
Phase 1: order date February 02, 2022
Plasmin: 1 capsule 3 times a day. This was used to help clear infections caused by fungi in the bloodstream.
Bitter: 1 capsule 3 times a day. This removes the pro-inflammatory cytokines.
Formula F: 1 capsule 3 times a day. This was used to help clear the stomach from fungal infections and candida.
Phase 2: order date March 10, 2022
Plasmin: 1 capsule 3 times a day. This was used to help clear infections caused by fungi in the bloodstream.
Bitter: 1 capsule 3 times a day. This removes the pro-inflammatory cytokines.
Formula F: 1 capsule 3 times a day. This was used to help clear the stomach from fungal infections and candida.
Whitehead: 1 capsule 2 times a day. Removes toxins from the large intestine.
Phase 3: order date April 13, 2022
Plasmin: 1 capsule 3 times a day. This was used to help clear infections caused by fungi in the bloodstream.
Bitter: 1 capsule 3 times a day. This removes the pro-inflammatory cytokines.
Formula F: 1 capsule 3 times a day. This was used to help clear the stomach from fungal infections and candida.
Whitehead: 1 capsule 2 times a day. Removes toxins for the large intestine.
While on the above protocol, she was also on a modified candida diet, which included reduced sugar intake to reduce the food source for candida. Since she is vegetarian, in order to make complete amino acids, she still has a sugar intake, but it was reduced. As for the rest of her diet modifications, a shift to a more complete amino acid profile was very important to help the body heal appropriately.
She was also on the below supplements for the following:
- Multivitamin O.N.E: for nutrient support
- Omega 3: for healthy fat supplementation
- Egg White Protein: protein source to help with appropriate protein intake in a complete source
- Amino Acids: to help with protein in a complete source
- Menopause Support: to address hot flashes
- HCL & Pancreatic Enzyme: to help with digestive issues such as burping
6 Month Follow-Up:
At her 6 month follow-up, she reported being able to walk one and a half hours at the zoo with no pain in her feet or in her vulva. She is currently working out at a gym 3 days a week. This movement has been great for her overall health. Adding in the layer of being at a gym has also provided her with a great community of support. Prior to her completing the above interventions, she could not stand for 5 minutes without having any foot pain and can now tolerate doing a warm-up without shoes on before her workouts.
[signup]
Summary
This case really shows the importance of a team approach addressing both movement and gut health. This patient had worked with many professionals previously who worked on some strengthening and mobility of the areas in which she was experiencing pain. Adding the layers into the functional movement was one component that made some improvement. But, what made the biggest impact was listening to the symptoms the patient had been experiencing after years of different treatments and assessing the gut to figure out the root of the chronic pain she was experiencing. After addressing the candida, SIBO, and oxalates in her gut, she was able to experience less pain and get back to moving with a great foundation.
Learn More
Lab Tests in This Article
%201.svg){kind=logo}
References
- Bergeron, S., Reed, B.D., Wesselmann, U. et al. Vulvodynia. Nat Rev Dis Primers 6, 36 (2020). https://doi.org/10.1038/s41572-020-0164-2
- Glazer H.I., Ledger W.J. Clinical management of vulvodynia. Reviews in Gynaecological Practice, Volume 2, Issues 1–2, 2002. Pages 83-90, ISSN 1471-7697. https://doi.org/10.1016/S1471-7697(02)00018-7.
