Let’s Talk about Pelvic Pain
By Lexi Burtman
Pelvic Floor Physical Therapist
Most of us have basic knowledge of what to do when we get a sore throat, headache or back pain, yet we often don’t know what to do when we experience pelvic pain. First, we need to understand what pelvic pain is and how to describe it. Vaginal burning, pelvic discomfort while sitting, and pain with penetration all result in a general diagnosis of “pelvic pain.” While there is often variability in treatment based on the symptoms, the overarching problem is people don’t know what to do when they have these symptoms, or even how to explain them to their doctor. There is no shame or stigma around pain elsewhere in the body so there most definitely should not be a stigma around pelvic pain either. Shedding that stigma and pain starts with addressing it head on – calling it what it is and certainly not using flowery euphemisms to refer to parts of our body.
A study done by the Eve Appeal, a UK gynaecological cancer charity, found that 1 out of every 10 women ages 16 to 35 said they found it hard to talk to their GP about gynaecological health concerns and nearly 40% of 16–25-year olds said they resort to using “code” names for their genitalia. Many of the young women surveyed also couldn’t correctly identify their internal and external genitalia on a simple diagram.
Let’s go over the basics: the vulva is the external genitalia. This includes the labia, clitoral area and urethral opening. The vestibule is the tissue between the vulva and the vagina. How are we going to bring up pain with sex and pelvic pain to practitioners and partners if we don’t feel comfortable addressing our body by its correct anatomical name? Using code names, being unfamiliar with our anatomy, and not talking about pelvic pain further increases the stigma and unknown of pelvic pain.
Taking control starts with education. Far too often patients come in for treatment who have been suffering for years. It’s incredibly common, but they have not had the knowledge or confidence to describe their experience. They think they are the only ones, when pelvic pain is much more common than anyone realizes.
Below is a list of 4 broad diagnoses that stem from pelvic pain. Having a diagnosis and the correct terms to describe the experience is a great starting point to address and alleviate these conditions.
If you suspect you have one of these conditions, you should discuss it with your health care practitioner.
Pelvic Floor Dysfunction (PFD): The pelvic floor is made up of muscles, ligaments and tissues between the pelvic bones. The function of the pelvic floor is to support the bladder, uterus, and rectum. Pelvic Floor dysfunction occurs when these muscles are weak and/or tight. The pelvic floor has many functions and therefore there are many different types of PFD. A tight, weak or uncoordinated pelvic floor would impact bladder function and present as urinary leakage, frequency, or hesitancy. PFD can also present in bowel dysfunction as fecal leakage or difficulty fully emptying the bowel. It also can result in diminished sexual function such as pain with penetration or decreased sensation and lack of orgasm. Treatment entails working with a healthcare practitioner to determine the cause of the dysfunction, as well as treating the symptoms individually.
Vaginismus: This is muscle spasm in the pelvic floor muscles. The tissue is intact, there is no visible change to the skin but muscle spasms of the pelvic floor occur. Muscle spasms can make it painful, difficult or impossible to have sexual intercourse, insert a tampon or have a gynaecological exam. When the muscles that surround the vaginal opening are in constant spasm, they can end up shortened and contracted over a period of time. Some patients describe this feeling like you are “hitting a wall” when inserting things into the vagina. The use of vaginal dilators can be very helpful for those struggling with Vaginismus.
Vulvodynia: The sensation of burning and irritation in the vulvar area, which is made up of tissue. Some causes of tissue irritation can be hormonal insufficiency, dermatological skin conditions, muscle dysfunction, childbirth, pelvic surgeries, nerve irritations, yeast infections, and bacterial vaginosis. This sensation and pain can remain even when the skin condition or infection has cleared. Symptoms can be constant, known as unprovoked vulvodynia, or exhibited only with touch, known as provoked vulvodynia. Vaginal dilators are a very helpful treatment, as an addition to the medication, to treat the root cause.
Vestibulodynia (Vulvar Vestibulitis): The tissue between the vulva and the vagina, the vulvar vestibule, is very susceptible to break down. The vestibule contains highly sensitive nerve endings that can become easily irritated. Irritation frequently occurs from repetitive yeast infections. Other causes of tissue breakdown and irritation can be hormonal imbalances from oral contraceptives, hormone suppression therapy, menopause, breastfeeding etc. An imbalance or total lack of specific hormones can compromise the tissue, resulting in pain, discomfort and burning. The tissue will typically look irritated upon inspection. Similar to the treatment of other pelvic conditions, vaginal dilators are a beneficial addition to medication.
The first step to a diagnosis and treatment plan is talking about it. If we talk openly about our vaginas and pelvic pain, people suffering from these conditions will have a better understanding and will feel less of a barrier to seeking treatment. As Pelvic Floor Physical Therapists, we see this barrier first-hand, and so we founded Elevated Pelvic Products with this idea at its core. Our mission is to spotlight pelvic pain through education and to provide accessible tools for relief. We designed our medical-grade silicone dilators to be inclusive, fun, and easy to use.