There are many possible causes of pelvic pain and pelvic floor muscle dysfunction 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 or other specialist depending on the cause of your pain.

Pelvic pain or chronic pelvic pain which has a musculoskeletal origin is often treated by a specialist pelvic physiotherapist (sometime referred to as a women’s health physiotherapist or men’s health physiotherapist).

 

What is the Pelvic Floor

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.

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

 

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.

Pelvic Floor Muscle Dysfunction refers to a state in which the muscles of the Pelvic Floor are not working optimally. In some patients this may mean there is excessive muscle tension, scarring or the presence of trigger points (areas of muscle spasm).

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

 

Progressive dilator therapy helps women improve their vaginal health by learning how to control and relax the pelvic floor muscles.  Treatment may also include relaxation techniques and therapy.

Soul Source dilators and EZMagic therapeutic aid for internal massage are the first choice for treating healthcare professionals. A wonderful self treatment guide to help women who experience painful intercourse is Heather Jeffcoat’s book, Sex Without Pain: A Self Treatment Guide to the Sex Life You Deserve, available alongside other resources in our shop.

 

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

Dyspareunia

Dyspareunia is a feeling of pain during or after sexual intercourse. It is sometimes confused with vaginismus, but it is different, as in vaginismus the pain is caused by involuntary spasms of the pelvic muscles which surround the vagina.

Dyspareunia is a feeling of pain during or after sexual intercourse

 

Actually, these pains are quite common, especially in menopausal women, as their ovaries stop producing high levels of oestrogen and progesterone. Oestrogen is responsible for maintaining the thickness and health of the vagina walls and facilitate the normal functioning of the vagina during intercourse. When oestrogen levels are low, the vaginal walls become thinner and dryer, thus conducting to painful intercourse.

 

Other common causes of dyspareunia include:

  • 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
  • Size mismatch between sexual partners (i.e. penis too big for the vagina) or resuming intercourse after a prolonged period of abstinence
  • Some lubricants, spermicidal creams or gels, and latex condoms can act as an irritants
  • Breast-feeding can lead to vaginal dryness and painful intercourse
  • Pelvic inflammatory disease can lead to painful sex, together with other symptoms such as fevers, chills, hot flashes, and foul discharge
  • Descent of the uterus (prolapse) can lead to painful sex for the woman, associated with a feeling that something is falling out of the vagina, and for the man with an unusual sensation during sex
  • Some psychological factors can lead to lower libido and painful intercourse (close death, financial problems, major illness, etc.)

 

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 as: whether previous intercourse was painful as well, if there is enough natural lubrication, whether there is a possibility to have contracted a sexually transmitted disease, or whether or not there is a history of abuse.

 

Treating dyspareunia

Fortunately, the recovery rate for the majority of dyspareunia causes is extremely high. The treatment must be chosen depending on the main cause of the discomfort:

  • The use of lubricants, when the cause is inadequate natural lubrication
  • Oestrogen replacement therapy for menopausal women
  • Dilation therapy using vaginal dilators
  • Treatment for cysts or other lesions involved
  • Abstinence while problems or infections heal
  • Surgery to remove painful lesions

 

Our Soul Source dilators and EZMagic for internal massage are the first choice for treating healthcare professionals. A wonderful self treatment guide to help women who experience painful intercourse is Heather Jeffcoat’s book, Sex Without Pain: A Self Treatment Guide to the Sex Life You Deserve, available alongside other resources in our shop.

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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