Francesca Galiano
26/09/2023 - Last update 24/11/2023

Athina Giovanis, Stephanie Zeszutek | Year 2020

Somatic Dysfunctions of Hip and Pelvis Overlooked in a Case of Vulvodynia


Gynecological and obstetric disorders

Type of study:

Case Report

Date of publication of the study’:



Purpose of the study

  • Objective: to show the usefulness of OMT in treating vulvodynia and related depression symptoms
  • Measured outcomes: evaluation of the symptoms


  • Number: 1
  • Description: a 40-year-old woman with chronic perineal pain that had began a year earlier following a vigorous walk that had induced acute pain in her left hip, hamstring, and buttock. The pain would get worse when she lay on her left side or after sitting for a long time. Sexual intercourses had also become painful.
    Cystoscopy and vaginal ultrasonography were normal. For 6 months she followed physical therapy treatments (which also included ultrasounds, dry needling, SI support belt and left heel lift). Then, for 3 months she followed physiotherapy treatments specifically targeting the pelvic floor. However, due to poor results, she received 3 injections in the trigger points and 4 vulvar injections of Botox, but with temporary effects.

For the past 6 months she had been taking amitriptyline daily, but with no improvement, while for the past 3 months she had been taking gabapentin: although this medication had induced improvement, it made her feel tired and down, so much so that she described herself as depressed.
The patient was an accountant, married to a man described as sweet and supportive. She had no children, no history of any particular illness or surgery. She was taking contraceptives and multivitamins, while she did not use tobacco, alcohol, or drugs.
Physical evaluation showed prevalent somatic dysfunctions in the left hand side of her body at the level of the sphenobasilar symphysis, thoracolumbar junction, sacroiliac joint with decreased primary respiratory mechanism, suprapubic fascia, pelvic floor, hip, left leg, buttock, harmstrings, ribs and diaphragm muscles.

Interventions and evaluations

  • Evaluation of the symptoms.
  • Hip MRI after first visits.
  • 8 OMT sessions: 5 weekly and 3 monthly.
  • OMT: balanced ligamentous tension techniques, myofascial release, cranial osteopathy, with focus on the pelvic diaphragm in relation to the thoracic diaphragm and breath.


After the first visit, the functional impairment of the left leg had been corrected and, therefore, the patient was advised not to wear an insole any more.
At the first follow-up visit the vulvodynia had also decreased and sitting was less painfull, whereas her left hip and hamstrings’ pain was more noticeable. Pelvic floor restrictions had decreased, synchrony of movement between the pelvic and thoracic diaphragms had increased, but several somatic dysfunctions were still present.
An MRI of the left hip revealed a tendinopathy at the level of the tendon of insertions of the harmstrings, but without injury or effusion.
During the following 3 weekly visits, the vulvodynia continued to decrease, and so did the pain and the symptoms of depression.
After 3 monthly visits, the patient reported feeling better and was able to discontinue the gabapentin.


OMT has been shown to contribute to the resolution of the patient’s perineal pain and associated depressive symptoms.

Taking into account the complexity of the management of vulvodynia – which may involve behavioral changes (hygiene, bathing, topical lubricants), counseling, exercises, physiotherapy, topical medications (eg, lidocaine or capsaicin creams), drugs such as antidepressants or muscle relaxants, steroid or botox injections, and surgery – OMT may play an important role in assessing the structural and functional aspects of the pelvic region in relation to the rest of the body (eg, lower extremities and thoracic diaphragm).

Most likely, the patient had injured the attachment of the hamstrings to the ischial tuberosity during the vigorous walk, an injury that then induced a series of somatic dysfunctions ultimately leading to vulvodynia.

The principles of osteopathy also allow the practitioner to implement a comprehensive approach that helps define a therapeutic relationship that can improve compliance and therapeutic outcomes.

Of course, further studies are needed both on OMT and multimodal approach.

The review of Osteopedia

By Marco Chiera

Strengths: first study to report the usefulness of OMT in vulvodynia; initial anatomic framing useful; changes on depressive symptoms reported; follow-up of several visits and interesting focus on  multimodal approach.

Limits: like any case report, it is difficult to generalize its results; longer-term follow-up is lacking; it would have been interesting to assess, even in a simple way (0-10 scale), both pain intensity and depressive symptoms.

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