Transcript of VPS Podcast 6 - Vulval conditions and the new NHS: a presentation given by David Nunns

Specialist physiotherapy for pelvic floor muscle rehabilitation – that is their role. We know that in vulvodynia there is a hypertonicity, an excess tightness in the pelvic floor muscles, and these very skilled non-medical staff, they’re physiotherapists by training, will work on pelvic floor rehabilitation. This is of benefit in women with unprovoked vulvodynia. Referral by a GP – but look at that, you usually get 45 minutes for consultation, a much longer period of time, and again, they may not be that happy looking at your vulva to look for skin problems.

CBT we’ll come onto this afternoon – I think there is a lot to be said for this type of therapy. For chronic pain, there are lots of benefits. I think you can access it via various routes - referral by a GP, you can even self-refer, I think. I have a bit of an information gap around referral into that, but I know that that’s the focus of today, so perhaps we can touch on that later on. The principles are there, but again, you probably won’t be examined if you’ve got a vulval problem in that setting.

Sexual therapy: again, a key part of the management of vestibulodynia. Lots of benefits there – the one I’ve put here is vaginismus management. Again, you’d get referred by your GP or by the hospital as a part of the extended team, but you’re generally getting 60 minutes of history and counselling and treatment. Again, many sexual therapists will not examine you, but some will.

And acupuncture: again, self-referral usually. You often have to pay for this service because this is what has been withdrawn in the modern NHS, but it’s an established treatment, it has a role in chronic pain management and I put it in there because many women have benefitted from it.

My point really is to show you this extended team, as it were, when it comes to vulval problems.

So that’s a bit about where we’d like to go with this problem with vulval conditions, and I’m optimistic in the future that this will improve.

Just some bits and pieces, really, to take home in terms of working with health professionals. I’m very mindful of the fact that when you come to the hospital, you have driven a long way, you’re in pain when you come to the hospital, you’re sitting in the waiting room for an hour, parking’s a problem, there’s a great deal of anxiety around coming to see the hospital specialist, and we know that people just don’t take the information in when they’re seen by their doctor. What a waste of time! It might feel like a waste of a consultation – you didn’t get your words out, you didn’t understand what the doctor said, he gave you a prescription and you didn’t understand the side-effects, and it’s all over and done with within about 20 minutes, or if you’re lucky, half an hour. That’s half an hour’s snapshot time in your life with pain, so you get half an hour of the hospital experience, the specialist’s experience. Which isn’t long. So you’ve got to optimise that time, you’ve got to make the most of that time. Take a friend; take somebody who can ask questions on your behalf. It’s perfectly reasonable to have somebody in the room with you. These are things that I would find helpful. Take a list of your medications. I give pain-modifying drugs out to patients with vulvodynia. It’s always good to know what you’ve tried before, how long you tried it for, what dose you got to, and whether you could tolerate it, yes or no, and did you get side-effects. In effect, just a summary sheet of what’s happened. Why do we do this? Because it avoids me giving you the prescription that you’ve already had before, and you end up duplicating a treatment that gave you a problem. That’s very helpful. Plus, certain drugs interact with each other, so we’ve got to be careful what we prescribe.