(033) Pelvic Health Physical Therapy at the Dermatology Interface: A Review of Overlapping Mechanisms and Management of Vulvar Pain

Abstract Introduction Vulvar pain syndromes, including vulvodynia and vestibulodynia, are multifactorial disorders that significantly affect sexual health and quality of life. These conditions often occur at the intersection of dermatologic and cutaneous disease and pelvic floor dysfunction, driven by overlapping inflammatory, neurologic, and musculoskeletal mechanisms. Vulvar dermatoses can provoke chronic irritation and barrier disruption, leading to pelvic floor hypertonicity and neural sensitization. Conversely, pelvic floor dysfunction may amplify cutaneous pain and inflammation. Despite this bidirectional relationship, collaboration between dermatology and pelvic health physical therapy (PHPT) remains limited. Emerging evidence supports PHPT as a key component of multidisciplinary care, addressing the neuromuscular contributors that perpetuate vulvar pain. This review synthesizes current literature to clarify mechanistic overlap and evaluate the role of PHPT within integrated dermatologic management of vulvar pain syndromes. Objective This review aims to highlight the shared pathophysiologic mechanisms linking dermatologic and pelvic floor disorders in vulvar pain syndromes, evaluate the evidence supporting PFPT as part of multidisciplinary management, and identify gaps in current understanding to guide future collaborative research and clinical practice. Specific attention is given to inflammatory, neurologic, and musculoskeletal overlaps, as well as to the integration of PHPT with dermatologic treatment approaches. Methods A narrative review was conducted using PubMed, Scopus, and Web of Science databases from inception to October 2025. Search terms included vulvodynia, vestibulodynia, pelvic floor dysfunction, pelvic physical therapy, lichen sclerosus, vulvar dermatitis, vulvar dermatoses, and vulvar pain. Studies were included if they examined mechanistic pathways (inflammatory, neural, or musculoskeletal) or therapeutic interventions involving PHPT in the context of dermatologic vulvar disorders. Data were synthesized thematically to highlight: the mechanistic overlap between dermatologic and pelvic floor pathology; reported outcomes of PHPT interventions; and the role of multidisciplinary care in improving pain, sexual function, and quality of life. Results Vulvar pain syndromes are multifactorial, involving inflammatory, neurologic, musculoskeletal, and psychosocial mechanisms. Common findings include elevated proinflammatory cytokines, hyperinnervation of the vulvar vestibule, and pelvic floor muscle overactivity, underscoring a bidirectional relationship between pelvic floor dysfunction and vulvar pain. Dermatologic disorders such as lichen sclerosus, atopic dermatitis, and contact dermatitis frequently contribute through barrier disruption, chronic inflammation, and increased cutaneous reactivity. Standard dermatologic management, including barrier repair, topical corticosteroids, and patient education, remains foundational. PFPT is consistently recommended when pelvic floor hypertonicity is present, with interventions including manual myofascial release, down-training, biofeedback, dilator therapy, and TENS. Across studies, PHPT was associated with clinically meaningful improvements in pain, sexual function, and quality of life, though large randomized controlled trials remain limited. Optimal outcomes were reported with multidisciplinary care integrating PHPT, dermatologic therapy, psychological support, and, in refractory cases, regenerative or immunomodulatory treatments. Multimodal management outperformed monotherapy in nearly all comparative studies. Conclusions Vulvar pain syndromes are best understood and managed through an integrated lens that recognizes the interplay between dermatologic and pelvic floor mechanisms. PHPT, especially when combined with multidisciplinary care, offers significant benefits for many patients, though further research is needed to refine protocols and address persistent knowledge gaps. Disclosure No.