Transcript of VPS Podcast 4 - Physiotherapy treatment for vulval pain: a presentation given by Helen Forth

This is a transcript of the soundtrack from VPS Podcast 4, a live recording of a presentation given by Women’s Health physiotherapist Helen Forth at the VPS Super Workshop in December 2010. The full slide presentation can be viewed at Podcast 4 – Physiotherapy treatment for vulval pain: a presentation given by Helen Forth.

A list of the papers cited in the presentation is available at References for VPS Podcast 4 - Physiotherapy for vulval pain: a presentation given by Helen Forth.

Timings of each slide are provided in order to aid quick location.


[Editor’s note, October 2015: Helen Forth informs us that since this presentation was recorded in 2010, her approach as a physiotherapist to treating vulval pain has changed somewhat in focus, and she would now place much more emphasis on pelvic floor muscle relaxation and trigger point release, and much less on pelvic floor exercises and biofeedback.]


Slide 1 (00:00)    Physiotherapy treatment for vulval pain

I am the clinical lead for Women’s Health Physiotherapy at the Royal Free [the Royal Free Hospital, London, UK]. We have quite a big and fairly unusual Women’s Health Physiotherapy service there at the Royal Free. I run quite a big service, with a big team of physios, so we are, I suppose, by default, a little bit of a centre in terms of receiving referrals for women with vulval pain who need physiotherapy treatment - partly that’s because we now have three consultants who actually specialise in treating vulval conditions, and have a special interest in vulval pain, so I will acknowledge that we do come at this from a slightly unusual perspective. What I’m going to talk about today is very much our approach at the Royal Free. There are definitely other centres that are taking a very similar approach now, and I think that physiotherapy in this area is really growing, and has really grown and developed in the last ten years. And actually, anybody who thinks that physios might not be interested or relevant as far as vulval pain is concerned… Can I just ask those of you who are Women’s Health physios to pop a hand up, because there’s quite a lot of you here…? Yes – thanks, guys! [Laughs]  

Slide 2 (01:08)    Content of presentation

So that I don’t run out of time, I shall move on, but this is the stuff that I’m hoping to cover. I do want to just give a little bit of an overview about what Women’s Health Physiotherapy actually is, and then also talk about what physiotherapy treatment might involve. This will consist of all or some of the things that you can see listed there, so perhaps pelvic floor muscle rehabilitation, perhaps biofeedback, something that tends to get called ‘desensitisation’ now (I’ll elaborate on that a little bit as I go along), possibly relaxation, and then also assessment and treatment of associated problems. And actually Andrew [Andrew Baranowski, a pain management consultant and earlier speaker at the VPS Super Workshop 2010], who spoke to us earlier, spoke very eloquently about the fact that there is a massive overlap with other conditions: we do see a lot of women who’ve also got bladder or bowel problems, or other problems with their musculoskeletal system, whether it’s back pain, or pelvic pain, or a combination of those things, so I’m going to touch a little bit on that as well. Then also, because I think you might be interested, I want to talk a little bit about whether physiotherapy works or not – whether we know whether physiotherapy works or not, and what research is out there at the moment.

Slide 3 (02:17)    What is Women’s Health Physiotherapy?

In terms of just thinking about what Women’s Health Physiotherapy is – I do apologise to those of you who are Women’s Health physios - hopefully you know all of this! [Laughs] ‘Physiotherapy uses physical approaches to promote, maintain and restore physical, psychological and social wellbeing…’ It’s science-based, it’s ‘committed to extending, applying, evaluating and reviewing the evidence that underpins and informs its practice and delivery. The exercise of clinical judgment and informed interpretation is at its core.’ That’s taken from the Chartered Society of Physiotherapy, which is our professional governing body. 

Slide 4 (02:53)    What is Women’s Health Physiotherapy? (continued)

So, what is a Women’s Health Physiotherapist? ACPWH, which stands for the Association of Chartered Physiotherapists in Women’s Health is a physiotherapy special interest group. It comes under the umbrella of the Chartered Society of Physiotherapy, but it’s a subgroup of physiotherapists who specialise in working in women’s health. To be a member of ACPWH, a postgraduate qualification in Women’s Health Physiotherapy or continence is required, so physiotherapists who are members of ACPWH are specialists who have undergone accredited courses in this particular area. Members of ACPWH specialise in the physiotherapeutic care of women in relation to a whole bunch of things, but childbirth may be part of that, treatment of incontinence, both male and female, and in the care of women undergoing gynaecological surgery. Along with that, although it’s not part of the formal definition, is pelvic pain, and vulval pain as well. In Gynaecology ‘professional expertise, combined with sensitivity and understanding is invaluable to patients… Some members of ACPWH take part in psychosexual counselling workshops which enable them to help patients with sexual problems’, and obviously that’s very relevant for a lot of you today.