There are many possible causes of pelvic pain and the reason for your individual pain should always be discussed with your GP or physiotherapist. They may refer you onto a specialist gynaecologist, urologist, gastroenterologist, psychosexual counsellor or other specialist depending on the cause of your pain.

 

What is Chronic Pelvic Pain?

Chronic Pelvic Pain (CPP) is any pain in or around the pelvis that lasts for more than 6 months, it can affect both men and women and can occur at any age. CPP can impact on every aspect daily life and can change the way an individual behaves emotionally and physically. It can be extremely isolating as the cause of the pain is rarely visible on the outside.

 

What Causes Pelvic Pain?

There is no simple answer to this question and a range of conditions can impact pelvic health and lead to pelvic pain, these include but are certainly not limited to:

  • Menopause
  • Endometriosis
  • Adenomyosis
  • Polycystic ovary syndrome
  • A fall or trip (even one which is seemingly innocuous)
  • Allergies or irritation
  • History of sexual abuse
  • Surgery
  • Treatment for cancer
  • Infections
  • Childbirth
  • Postural problems
  • Dermatological conditions
  • Sjogren’s Syndrome

Pelvic Floor Muscle Dysfunction

The Pelvic Floor is made up of the muscles, ligaments, nerves and tissue that sits at the base of the pelvis. It attaches to the pubic bone at the front all the way through to the tailbone at the back. It is often described as acting like a sheath or sling to support the pelvic organs – the bladder, bowels and reproductive organs but also assists in bladder, bowel, sexual function as well as trunk stability and mobility. Too often we think only of the pelvic floor being weak however the pelvic floor is extremely complex and the muscles need to work together, like a well trained orchestra, relaxing and contracting at different times.

A common cause of pelvic pain is a result of the muscles and nerves within your pelvis not working optimally, frequently muscles will spasm when pain is experienced or even anticipated feeding into a further cycle of pain. Frustratingly changes in the way the nerves carry messages can often result in the pain remaining a long time after the initial cause has been identified or even treated. Pelvic pain or chronic pelvic pain which has a musculoskeletal origin is most commonly treated by a specialist pelvic physiotherapist (sometime referred to as a women’s health physiotherapist or men’s health physiotherapist).

The pelvic floor supports the pelvic organs, assists in bladder, bowel and sexual function and provides trunk stability and mobility.

 

Treating Pelvic Pain

Unfortunately we don’t have all the answers. However, here at Pelvic Relief we have sourced the best products possible to compliment your treatment plan. All these products are recommended by healthcare professionals and we hope they will help you achieve your goals.

If you have been recommended graded dilation therapy our SoulSource dilators  are made from the highest quality silicone rubber which is smooth, soft and naturally flexible to conform gently to your bodies needs. They come in a wide range of sizes and can be purchased individually or in sets.

If your Physiotherapist has recommended internal massage EZMagic is the first choice recommended by treating healthcare professionals. Made from medical grade glass it can be heated or cooled and is perfectly shaped to access different areas of the pelvic floor.

If meditation or yoga is part of your treatment plan the Buttafly is a yoga block designed by a Physiotherapist to address the challenge of sitting comfortably on the floor.

Vaginal dryness may be a primary symptom of your condition (for example as a result of Menopause or Endocrine Therapy) or may be a result of the anticipation that intercourse will be painful. We always recommend YES Organic Moisturisers and Lubricants, formulated to be free from hormones, parabens and known skin irritants.

If sexual activity has become painful, Ohnut is the first intimate wearable that allows couples to explore comfortable penetration depths.

We have some wonderful self treatment guides including Heal Pelvic Pain by Amy Stein and Heather Jeffcoat’s book, Sex Without Pain: A Self Treatment Guide to the Sex Life You Deserve to help women who experience painful intercourse.

Vaginismus (Pelvic Floor Myalgia)

Vaginismus is the involuntary spasm of a woman’s pelvic floor muscles which surround the vagina. These spasms can be so severe that the vagina closes, leading to painful sex (dyspareunia), painful tampon insertion and a difficult pelvic exam. The pain is most often a burning sensation that may develop as sexual intercourse progresses. Vaginismus is the leading cause of unconsummated sexual relationships. There are varied causes, yet most clinicians believe it has both a physical and emotional component.

 

60% of women with vaginismus are married

 

There are four different classifications:

  • Primary vaginismus (lifelong)
  • Secondary vaginismus (occurring after a period of normal sexual function)
  • Global vaginismus (occurring in all situations: intercourse, tampon insertion, or pelvic exam)
  • Situational vaginismus (occurring when experiencing painful intercourse with only one partner, but not others, or only during sex but not with tampon insertion or pelvic exams.)

 

53% of women with Vaginismus are aged 25-35

 

Dilation therapy successfully treats vaginismus in 75 to 95 percent of women

Dyspareunia

Dyspareunia is the term that specifically relates to a feeling of pain during or after sexual intercourse.

 

Dyspareunia is a feeling of pain during or after sexual intercourse

 

Dyspareunia is extremely common amongst women who have pelvic pain. The underlying cause will vary between women and the treatment can be frustrating and time consuming and may require a multifaceted treatment approach.

Common causes of dyspareunia include:

  • Menopause
  • Anxiety
  • Postural issues
  • Muscle spasms
  • Lichen Sclerosus
  • Sjoogren’s Syndrome
  • Cancer treatment
  • Cysts, genital warts, herpes, or other such lesions or abrasions within the vulva or vagina
  • Scarring from childbirth, episiotomy (an incision made by surgeons to facilitate birth), laceration repair or other vaginal surgery
  • Cystitis or other urinary tract infections
  • Resuming intercourse after a prolonged period of abstinence
  • Irritation or allergy to some moisturisers, lubricants, spermicidal creams or gels
  • Breast-feeding can lead to vaginal dryness and painful intercourse
  • Pelvic inflammatory disease
  • Endometriosis
  • Descent of the uterus (prolapse)
  • Psychological factors

 

Diagnosing dyspareunia

Establishing a dyspareunia diagnose involves a physical examination and the acknowledgement of symptoms resulting from medical and sexual history. It is important to give the therapist details such as the exact location, length, timing, and frequency of the pain, for him/her to establish various details and whether previous intercourse was painful as well.

Vulvodynia

Vulvodynia is vulvar pain, of at least 3 months duration without a clear identifiable cause. The vulva, refers to the external female genital organs, which includes the labia, clitoris, and vaginal opening.

 

It is estimated 15%-28% of women worldwide suffer from vulvodynia

 

The pain can be experienced in very different ways by individuals. It may be localised to one area e.g. clitorodynia (pain at the clitoris) or generalised over the whole vulva. Some patients will have mixed pain, that is localised and  generalised.

In some patients the pain will be described as ‘provoked’ when contact causes the pain; in others pain may be spontaneous and occur without an apparent trigger. Some patients will be familiar with both spontaneous and provoked pain. The onset of the pain may have been the first symptom in some patients, which is described as primary; in others the pain will be a secondary symptom perhaps following another illness or event.

The times pain is experienced will also differ between women, in some it may be intermittent in others persistent. In some the pain will be immediate when provoked, in others there may be a delay between provocation and the feeling of pain.

 

Symptoms of Vulvodynia usually begin suddenly and can last anywhere from months to years.  These symptoms can include:

  • Burning sensation
  • Stinging or rawness
  • Painful sex (Dyspareunia)
  • Aching, soreness, or throbbing
  • Itching

Although doctors don’t fully know what causes most forms of Vulvodynia, researchers believe that some of the causes could be:

  •     Nerve injury or irritation
  •     Abnormal response to an infection or trauma
  •     Genetic factors
  •     Hypersensitivity to yeast infections
  •     Muscle spasms
  •     Allergies or irritation to chemicals or other substances
  •     Hormonal changes
  •     History of sexual abuse
  •     Frequent antibiotic use

Many health care providers may not be familiar with Vulvodynia.  Women suffering from Vulvodynia  should look for a doctor, sex therapist or physiotherapist that is knowledgeable about this condition.  Although there is no cure, there are treatments that can help bring relief. Use of vaginal dilators or therapeutic aids for massage may be recommended by your physiotherapist or healthcare practitioner which can help women learn to relax vaginal muscles to lessen pain.

 

Nearly 40% of women with vulvodynia choose not to seek treatment

Chronic Pelvic Pain in Men

Pelvic Pain in men, as women has many potential causes. The most important step in understanding your condition is to get a full diagnosis from your GP or healthcare professional. Your GP may refer you onto another specialist for further investigation or treatment.

What is Chronic Prostatitis or Chronic Pelvic Pain Syndrome (CPPS)?

Prostatitis can be subdivided into four different categories:

(i) Acute bacterial prostatitis:

An acute infection, usually caused by bacteria in the urinary tract (the kidneys, bladder, and the tubes that connect them) entering the prostate. Symptoms include fever, chills, pain in the low back and genital area, body aches, urinary frequency, nocturia (night-time frequency), painful urination (typically burning) and possible penile discharge. The symptoms are severe and develop suddenly; this is rare, but can be serious and requires immediate treatment. See your GP immediately for antibiotic treatment if you suspect you have this condition.

(ii) Chronic bacterial prostatitis:

Recurrent infection of the prostate. This condition is rare (less than 5 percent of patients diagnosed). The symptoms mimic intermittent acute bacterial prostatitis. The treatment is a prolonged course of antibiotics. Men with this condition may require physical therapy if antibiotics don’t help. Recurrent infections may be caused by incomplete urinary evacuation or by prostatic stones.

(iii) Chronic non-bacterial prostatitis/chronic pelvic pain syndrome (CPPS)

This is a term used for unexplained chronic pelvic pain without evidence of a urinary tract infection. Pain may be located in or around the groin, genitalia or perineum.

This may or may not occur with inflammation. Symptoms include discomfort or pain in the pelvic region including back, rectum and/or penis. CPPS is also commonly associated with urinary symptoms, sexual difficulties and pain with sitting.

This condition is considered chronic as it lasts longer than 3 months. Antibiotics typically do not help with this diagnosis. This condition may be caused by myofascial trigger point pain or nerve inflammation. Treatment includes physiotherapy and behavioural therapy.

(iv) Asymptomatic inflammatory prostatitis:

Typically, a person with this condition has no genitourinary symptoms, but higher levels of white blood cells have been identified during evaluation. Prostate cancer needs to be ruled out through a PSA (prostate-specific antigen) test given by your urologist.

Other Chronic Conditions?

There are other conditions related to pelvic floor dysfunction in men that may cause pain, examples include Proctalgia Fugax, Levator Ani Syndrome, Anismus, Coccydynia, Pudendal Neuralgia and Sexual Dysfunction. These conditions are recognised by the type, location and frequency of the pain and muscle spasming. They are often linked to other symptoms such as constipation or sexual dysfunction due to the involvement of the pelvic floor in bladder, bowel and sexual function. As with all these conditions getting a referral from a GP to an appropriate specialist or physiotherapist will ensure you get the correct treatment and will allow you to incorporate the self help strategies that are possible with EZMagic and Amy Steins book and DVD, Heal Pelvic Pain.

 

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