Localized Provoked Vulvodynia (LPV) affects up to 28% of women during their lifetime, with around 8% of American women currently experiencing it. LPV is defined as persistent vulvar pain without a clear cause such as infection, skin disease, or other identifiable pathology.

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What the Research Shows


A 2017 review by Falsetta et al. explored the inflammatory basis of LPV. Researchers found that:

  • Fibroblast cells from the vulvar vestibule in LPV patients were highly responsive to proinflammatory stimuli.

  • These cells produced high levels of pain-related inflammatory mediators, pointing to inflammation as a key contributor to symptoms.

In 2018, the same team expanded on these findings:

  • They discovered that human vulvar fibroblasts express Toll-like receptors (TLRs)—key sensors that trigger immune responses.

  • TLR activation was linked to proinflammatory signaling and chronic pain.

  • Suppressing TLR activity may offer a promising medical treatment pathway.

What This Means for Clinical Care

While pharmacologic approaches targeting inflammation may offer future promise, pelvic physical therapy remains a cornerstone of LPV management.

Effective PT interventions include:

  • Desensitization training and graded exposure

  • Manual therapy to release soft tissue restrictions

  • Pelvic floor muscle retraining

  • Dilator therapy for vestibular desensitization

  • Lifestyle and pain management education

A Multidisciplinary Approach

 LPV is not just a musculoskeletal issue—it’s a complex pain condition with an inflammatory component. Recognizing when to refer patients for medical management of inflammation, while continuing PT care, can lead to better outcomes.
  1. Benkhadra K et al. Menopausal Hormone Therapy and Mortality: A Systematic Review and Meta-Analysis. J Clin Endocrinol Metab. 2015;100(5):1756–1761.
  2. Salpeter SR et al. Mortality associated with hormone therapy in younger vs older postmenopausal women: A meta-analysis. J Gen Intern Med. 2004;19(8):791–804.
  3. Boardman HM et al. Hormone therapy for preventing cardiovascular disease in post-menopausal women. Cochrane Database Syst Rev. 2015.

How do Vaginal Dilators Work?

When a vagina feels tight, a dilator gently loosens and expands the vaginal opening and canal, allowing you to progress at your own pace and increase the size and length incrementally as comfortability increases over time. There are many resources on our website on how to stretch your vagina. Dilators train the vaginal muscles and tissues to relax and expand, encouraging blood flow and elasticity to the area and calming the associated nerves during sex, for example. Dilators also help women become psychologically more comfortable with the idea and feelings of penetration, increasing their level of comfort at their own pace and on their own time in the privacy of their homes. Overall this helps to increase self-confidence and calmness.

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About Intimate Rose

Intimate Rose is a trusted source for sensitive health issues related to pelvic health, hormone balance, digestive health, and cancer recovery. Our products are designed and endorsed by a Doctor of Physical Therapy, Dr. Amanda Olson, and made with the highest quality material for your safety and comfort.

About Dr. Amanda Olson, DPT, PRPC

You now have a true advocate. Dr. Amanda Olson's commitment to pelvic health developed from her own emotional and challenging experience first as a patient. In 2008, while on a family campaign trip, Dr. Olson fell over 40 feet into a river. She sustained a dislocation to her coccyx and significant damage to the muscles, tendons, and pelvic floor ligaments. Fortunately, Amanda saw a pelvic physical therapist who used a comprehensive evaluation, manual techniques, and exercises that allowed her to heal. That next year, she shifted her focus from pediatrics to pelvic physical therapy which eventually led her to Intimate Rose!