Content approved by: Dr Farzana Khan, MD, MRCGP, DFFP — Specialist in vaginal health with 20+ years’ medical experience across dermatology and gynaecology. Care is balanced, evidence-aware, and patient-centred.
Dr Farzana Khan qualified as an MD from the University of Copenhagen in 2003. She has worked in dermatology and obstetrics & gynaecology across the North of England and completed her MRCGP (CCT, 2013) and the Diploma of the Faculty of Sexual & Reproductive Health (2013).
Her clinical focus is vaginal health—including dryness/GSM, sexual function concerns, lichen sclerosus, and comfort or volume changes. She explains conservative and medical options first, then discusses regenerative or aesthetic procedures where appropriate.
Dr Farzana is a key opinion leader on women’s intimate health and been featured in the press including the daily mail and on BBC radio. Dr Farzana also trains clinicians as a Trainer with Neauvia, NuV Laser, Asclepion Juliet Laser, and RegenLab. Ongoing CPD includes IMCAS, CCR, ACE and expert training in intimate fillers, PRP and polynucleotides.
Authored and medically reviewed by Dr Farzana Khan. Last updated: 1 November 2025.
Study Guide: Understanding Pelvic Health and Sexual Comfort
This guide is designed to review and reinforce key concepts related to pelvic health, sexual comfort, and the various evidence-based and emerging treatments. Use this resource to test your knowledge and deepen your understanding of the material.
Part 1: Short-Answer Quiz
Instructions: Answer the following questions in 2-3 sentences each.
- What is the primary difference in mechanism and goal between vulvo-vaginal skin boosters and fillers?
- Explain why a patient undergoing an O-Shot (PRP) must avoid NSAIDs like Ibuprofen, while a patient recovering from vaginal laser treatment is encouraged to use them.
- Describe the fundamental distinction between how biofeedback and TENS therapy help manage pelvic pain.
- What is the "SHBG Trap" associated with hormonal contraceptives, and how does it impact sexual function?
- What is the "Toilet Seat Sign," and what condition does it strongly suggest?
- Why are brand-named sexual procedures like the O-Shot or G-Shot not endorsed by regulatory bodies such as the NHS or RCOG?
- What is the "Biofilm Barrier," and why does it contribute to the high recurrence rate of Bacterial Vaginosis (BV)?
- Explain the difference between Vaginismus and Provoked Vestibulodynia (PVD), particularly in the context of tampon pain.
- What are the "Nantes Criteria" used for, and what is the key symptom related to sitting?
- Why might a patient on systemic HRT still require local vaginal oestrogen to improve sexual comfort?
Click to Reveal Answer Key
1. Boosters vs. Fillers: Skin boosters use non-cross-linked hyaluronic acid to hydrate and repair tissue quality (for atrophy). Fillers use cross-linked hyaluronic acid to add volume and cushion (for structure).
2. NSAID Rule: PRP relies on inflammation to release growth factors, so NSAIDs block the treatment's effect. Laser causes swelling (edema), so NSAIDs are helpful to reduce this discomfort.
3. Biofeedback vs. TENS: Biofeedback is a "teaching tool" for conscious muscle control (down-training). TENS is a "pain blocker" that interrupts nerve signals to the brain.
4. The SHBG Trap: The pill increases Sex Hormone Binding Globulin, which binds to free testosterone. This lowers libido and can thin the vaginal entrance (vestibulodynia).
5. Toilet Seat Sign: Pain relieved by sitting on a toilet seat (which removes pressure from the perineum) suggests Pudendal Neuralgia.
6. Regulation: They are considered experimental or cosmetic due to a lack of robust, independent clinical evidence and are not medically necessary routine care.
7. Biofilm Barrier: A sticky slime layer protecting bacteria from antibiotics. Bacteria survive within it and re-emerge later, causing recurrence.
8. Vaginismus vs. PVD: Vaginismus is a muscular spasm ("hitting a wall"). PVD is nerve hypersensitivity ("burning/paper cut") at the entrance.
9. Nantes Criteria: Diagnostic criteria for Pudendal Neuralgia. Key symptom: Pain worsened by sitting.
10. Systemic Limitations: Systemic HRT circulates the body but may not be concentrated enough for vaginal tissue. 25% of women on systemic HRT still suffer from local dryness.
Part 2: Deep Dive Essay Questions
1. The Multimodal Approach
Discuss the concept of a "synergistic" approach to treating pelvic health. Explain the clinical rationale for combining therapies (e.g., Estrogen + Laser, Emsella + Physio) rather than using them in isolation.
2. Ethics, Consent & Safety
Analyze the role of informed consent in elective sexual wellness procedures. Address regulatory marks (UKCA/CE), the "Intended Use" trap, and the "Montgomery Standard."
3. Medications & Function
Compare how three medication classes (Hormonal Contraceptives, SSRIs, Antihistamines) negatively impact sexual comfort. What physiological processes are affected by each?
4. The Fear-Avoidance Cycle
Explain the "Fear-Avoidance Cycle" in chronic pain. Describe how therapies like physiotherapy, graded exposure, and lidocaine interrupt this cycle at muscular, neurological, and psychological levels.
5. Differential Diagnosis
Construct a differential diagnosis for "pain at the entrance." Differentiate between GSM, PVD, Lichen Sclerosus, and Vaginismus. What diagnostic tools (Q-Tip, pH test) would you use?
Part 3: Glossary of Key Terms
[Image of endometriosis vs adenomyosis uterus comparison]| Term | Definition |
|---|---|
| Adenomyosis | Endometrial tissue growing into the muscular wall of the womb, causing a "boggy" uterus and deep pain. |
| Allodynia | Pain from a stimulus that shouldn't hurt (e.g., light touch). A sign of PVD. |
| Biofeedback | A technique using sensors to visualize muscle activity, teaching conscious "down-training." |
| Biofilm | A protective slime layer created by bacteria (like in BV) that resists antibiotics. |
| Central Sensitisation | The nervous system amplifies pain signals; the "volume dial" is turned up. |
| Cytolytic Vaginosis (CV) | Overgrowth of "good" Lactobacilli causing acidity. Often misdiagnosed as Thrush. |
| DHEA (Prasterone) | A vaginal pro-hormone converting locally to estrogen and testosterone. |
| Endometriosis | Tissue similar to the uterine lining growing outside the uterus. |
| GSM | Genitourinary Syndrome of Menopause. Tissue atrophy due to low estrogen. |
| Hypertonicity | Chronic muscle tightness or overactivity. Often requires release, not Kegels. |
| Pudendal Neuralgia | Nerve pain in the "saddle area," characteristically worsened by sitting. |
| SHBG | Sex Hormone-Binding Globulin. Binds to testosterone, reducing libido. Increased by the Pill. |
