Pelvic, sexual and vulval pain are hidden problems and women often suffer in silence, or due to misdiagnosis, for years before they find help. They are very distressing problems and cause both physical and emotional suffering. People with pelvic or sexual pain may have been diagnosed with vaginismus, vulvodynia, dyspareunia, endometriosis, pudendal neuralgia, painful bladder syndrome, irritable bowel syndrome, and often have a combination of these problems contributing to their individual pain experience. Nerve and muscle overactivity, particularly in the pelvic nerves and pelvic floor muscles, lead to a number of problems, including ongoing pain in the region from increased tension and an inability to relax the pelvic floor muscles in anticipation of penetration, causing problems with sex, and pain with tampon use and internal examinations with care providers.
Common symptoms of pelvic pain:
- Painful sex
- Pain using a tampon
- Pain with internal examination e.g. having a pap smear
- Vulval pain with sitting or wearing tight clothing
- Painful periods
- Pain with bladder fullness
- Generalised, persistent abdominal and pelvic pain
- Coccyx (tailbone) pain
The Pelvic Pain Foundation of Australia is a great website to visit with some excellent resources and information sheets for people experiencing pelvic pain.
Persistent Pelvic Pain
Women with persistent pelvic pain (also known as ‘chronic pelvic pain’) experience some form of pain in the pelvis, which persists on most days for more than six months. It affects 15-25% of women and requires multi-disciplinary management for effective treatment – this means your physiotherapist will work with other health professionals in a team to help reduce your pain and improve your wellbeing.
Why do I have pelvic pain?
Everyone experiences pain in their own unique way and the underlying causes of persistent pelvic pain can be very different for each individual. We do know that pain is a normal and an important part of life. Your brain produces pain to protect you from potential dangers or threatening situations – it is vital for survival.
Sometimes the body’s danger alarm system becomes overprotective. The initial danger sensors could have been triggered in the bladder, bowel, uterus muscles, skin or elsewhere in the body. The danger sensors and pathways could have been activated by an infection, irritation or injury but also psychological and/or emotional trauma or experience.
In persistent pain conditions, changes occur in the nerve endings, nerve pathways, spinal cord, the brain and the immune system. These structures become sensitised and the body’s danger alarm system becomes easily and unnecessarily activated. This means that stimuli such as touch, stretch, warmth or cold which will not cause any tissue damage are now being interpreted by the brain as danger signals – and the brain will produce a real pain response to protect you, even though there is no actual threat to the body.
While all of the body’s protective systems and internal alarms can be turned up too loudly – we know that biologically, this can all be rewired, refreshed and reset – the nervous system changes are reversible – this is called bioplasticity.
For more information on the different types and triggers of pelvic pain, check out this free ebook: Introduction to Pelvic Pain.
How can I stop the pelvic pain cycle?
Your physiotherapist and multi-disciplinary team will ensure that other causes of your pain have been adequately investigated and treated. Once the original danger sensor triggers have been addressed, physiotherapy focuses on reducing secondary danger sensor triggers that may have developed such as tight and overactive pelvic muscles, as well as more generally beginning work to turn down the volume of the alarm system.
Understanding how pain works and the science behind your persistent pain condition is important to turn down the volume – we know that when you understand why you hurt, you hurt less.
The following books are great resources for learning more about pelvic pain
- Protectometer: The Explain Pain Handbook by David Butler and Lorimer Moseley
- Why Pelvic Pain Hurts by Adriaan Louw, Sandra Hilton and Carolyn Vandyken
Promoting pelvic pain recovery
Promoting recovery by addressing all aspects of the body’s protective systems means looking at optimizing exercise and physical activity, improving sleep quality, learning ways to desensitise tissues and better managing psychological factors that contribute to the sensitised alarm system such as stress reduction and addressing anxiety and depression and other mental health conditions that could be contributing.
Persistent pelvic pain is a complex issue and your physiotherapist needs time with you to understand your individual story. They will work collaboratively with you and other health professionals to reduce your pain and get you achieving your goals again.
There is strong evidence to support the role of pelvic floor physiotherapists with additional training in women’s and pelvic health to treat a number of conditions across all life stages – from more commonly known pelvic health issues affecting women such as incontinence and prolapse, to pelvic and sexual pain concerns and also for helping children and adolescents with bed wetting or other bladder/bowel control concerns.
We hope the information in this blog has been useful and should always be considered in conjunction with an individual assessment with your physiotherapist and/or other health care provider skilled in the area such as a GP or gynaecologist.
We would love to help you manage your concerns and get you back achieving your goals worry –free!