Pelvic Pain
One of the dearest subjects to my heart that has affected so many women who have come into my office to see me as a pelvic floor therapist has been pelvic pain. According to the NIH, chronic pelvic pain continues to affect 4-16% of the population of women. These are people who live the majority of their days having pelvic pain. Physical therapy can help patients with chronic pelvic pain and with intermittent pelvic pain.
Some people are misdiagnosed for years with pelvic pain just because for them it is not present all the time. So they forget it exists until it returns again sporadically. Pelvic pain may also present in individuals who have different cancer diagnoses (ie. breast, uterus, bladder, cervical, abdominal cavity). Pelvic pain also presents with diagnoses of endometriosis, dysmenorrhea (painful periods), painful bladder syndrome/interstitial cystitis. Some other diagnoses that cause pelvic pain may be irritable bowel syndrome, vulvar pain, vulvodynia, vestibulodynia, vaginismus, pelvic congestion, polycystic ovarian syndrome and pelvic pain due to undisclosed diagnoses after having a baby or a hysterectomy.
Pelvic Pain and Intimacy
Having pelvic pain can stress your marital relationships, place a strain on your mental health and even put you in a space of depressed mood. It can cause anxiety because you are not sure when it will return or you know exactly how it will return ie. in the bedroom. This is by far when enough is enough. It has been plaguing you for a long time but when you can no longer have intercourse with your partner and your intimacy has continued to plummet you have to do something about your pelvic pain NOW!!! Some women struggle with being afraid for your partner to touch your vaginal area because this may cause increased spasms in your pelvic floor. Others struggle with relaxing their pelvic floor muscles to empty their bowels or bladder.
There is a condition called vaginismus which is categorized as primary or secondary. Primary vaginismus happens when vaginal penetration is impossible because of pain you have experienced for your entire life. No object, speculum or penis is able to enter the vaginal canal. Secondary vaginismus happens when you were once able to have penetrative intercourse, but because of life’s circumstances now you can no longer participate in the act.
Pelvic Pain and Cancer Treatments
This occurs sometimes after having received treatment for cancer especially if you had a decrease in estrogen hormones, total hysterectomy, or radiation. These are things that your physicians may or may not tell you. Sometimes they educate patients that this could happen but most patients are so focused on decreasing their cancer that they look over this conversation and forget that pelvic pain could come as a result of treatment as a secondary issue. Tissues may be very dry, brittle and thin following treatments for cancer and after certain hormones have been reduced in the body. Our minds are also affected by lack of intimacy. Some women are in a place where they are so super stressed and there is a lack of concentrating on relaxation and breathing appropriately. Because of this penetrative intercourse cannot happen and pelvic pain is the result. Not breathing well affects how we move in the bedroom. There is a strong connection.
How to manage pelvic pain and how can your PT help?
This is the place where a pelvic floor PT can help reduce pain. There are 10 practical methods to help one reduce pelvic pain.
Remove unnecessary stressors from your life
Learn to breathe properly through your diaphragm
Learn how to relax your pelvic floor muscles with a pelvic floor physical therapist
Stretch muscles of your hips, low back and abdominal wall
Learn how to appropriately use a vaginal wand/dilators
Use lubrication
Communicate how you feel with your partner/spouse
Request a Pelvic Floor PT consult - (request a visit with me)
Get a mental health therapist or coach to help you talk through your intimate concerns
Exercise
I hope that you have found this information helpful and that you can apply some of these strategies to your daily routine if you have pelvic pain or know someone who does.
Be well!
About Dr. Katrina Heath
Dr. Katrina Heath is a physical therapist specializing in pelvic floor rehabilitation. She works with patients who have pelvic floor issues due to cancer treatment like surgery, radiation or chemotherapy.
