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Pelvic pain is perhaps one of the most distressing forms of pain. It affects 1 in 7 women in the US, and up to 32% of women worldwide. Chronic pelvic pain can result after injury such as a fall, car accident, pregnancy, and childbirth.
Some forms of cancer treatment and surgery in the pelvis, abdomen, or hip can also result in pelvic or vaginal pain. Pain can also result after emotional or physical trauma or abuse.
Musculoskeletal pain in the pelvis can result from the muscles of the pelvic floor (the muscles that support the pelvic organs) subconsciously contracting to protect the body.
While pain itself is an unpleasant phenomenon, pelvic pain can result in difficulty or inability to urinate, defecate, move freely, or engage in sexual intercourse.
The physical and emotional side of pelvic pain in women
This dysfunction often results in fear surrounding these normal human functions, social withdrawal, strain on relationships, humiliation, shame, and feelings of hopelessness.
Chronic pelvic pain is a curable condition; however many women experience years of misdiagnosis, or they are simply not taken seriously by their healthcare provider which leads to further feelings of hopelessness or frustration.
Pelvic pain can be manifested in the soft tissue areas of the body that do not show up on medical tests or certain types of imaging including x-ray or CT scan. It is often a component of how the brain interprets various signals from the body or from the external environment.
Body and the brain
For example, after a fall on slick ice a person may experience tailbone pain. The tailbone injury heals after eight weeks, and normal functioning resumes, however every time the ground becomes icy the individual may experience tailbone pain again.
This phenomenon is often attributed to the notion that the brain perceives the ice to be a threat and sends a warning signal of pain due to the built association of ice with the experience of pain.
This is not to say that pain is ‘all in one’s head’, and any healthcare provider insinuating that pain is merely a psychological experience should be avoided.
For example, upon reporting pain during sex to a provider, it is not uncommon for women to be told to ‘just relax’, ‘try having a glass of wine’, ‘light a candle’, or seek relationship counselling, without fully investigating the cause of the pelvic pain.
The body and brain must both be re-educated on how to coordinate the muscles to promote well-being and to resolve pain.
Common conditions that cause pelvic pain
A common condition associated with pain around the vagina is referred to as vaginismus. Vaginismus is the experience of vaginal tightness that causes pain, burning, cramping, spasms, and difficulty or inability to receive vaginal penetration.
Women who experience vaginismus may also experience fear, general anxiety, avoidance of certain activities including sex. They often develop protective guarding of the pelvic region by contracting the pelvic floor muscles.
These protective behaviours may include muscular guarding or clenching of the muscles in the pelvic floor, buttocks, hips, thighs, neck, chest, and shoulders. While healthcare providers may do certain tests and procedures such as ultrasounds or lab testing to rule out disease, these tests will come back negative in women with vaginismus.
Women with vaginismus don’t intentionally tighten or restrict the muscles, rather it is a reflexive response. This makes penetration difficult or impossible.
When intercourse is attempted, it can feel like a partner is crashing into a brick wall causing extreme pain, frustration, and sadness for both partners. Friction within the relationship is commonly experienced in couples with this issue.
Counselling and therapy (marital, couples, or sex) are highly recommended. By participating in both the physical and psychological components of training, while simultaneously receiving support from a counsellor or therapist, individuals or couples can learn new skills to support each other.
Often, a male partner simply does not know how to best support his female partner when pain is involved, which can lead to further distress for both partners.
The good news is that with practice and support from a team of professionals, pelvic pain is condition that is curable. Retraining the muscles to relax takes time and patience, but eventually, goals are met and a better quality of life is achieved.
Dr Amanda Olson is certified as an advanced pelvic floor practitioner (CAPP-PF) by the American Physical Therapy Association and the Herman and Wallace Pelvic Institute (PRPC).
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