Pelvic Pain
Vaginismus
Vaginismus is an involuntary spasm of the pelvic floor muscles in response to or in anticipation of penetration. It is the body’s automatic reaction to the fear of pain. Whenever penetration is attempted, the pelvic floor muscles contract on their own- like you have no control over it. This can occur due to previous painful experiences, fear or shame surrounding sexual activity, current or previous infection, childbirth related injuries, history of sexual abuse. Pelvic PT’s can help along with other members of the multidisciplinary team as needed. Treatment varies but may include pelvic floor muscle relaxation or desensitization, stretches for the pelvic floor muscles and surrounding structures, nervous system downregulation, dilator therapy, etc.
Vulvodynia
Vulvodynia is chronic, unexplained pain in the area around the opening of the vagina. Vulvodynia can be so uncomfortable that some activities can feel unbearable, such as sitting for long periods of time or having sex. Symptoms include burning and rawness in the genital area. Pain may be constant or occasional and can last for months or even years, then vanish as suddenly as it started. Treatment varies but may include avoiding behavior modifications like avoiding irritants such as tight-fitting clothing, perfumes, and dyes, activity modification, pelvic floor muscle relaxation or desensitization, stretches for the pelvic floor muscles and surrounding structures, nervous system downregulation, and more. Sex should also be avoided.
Dyspareunia
Dyspareunia is a condition where the person experiences persistent or recurrent genital pain that occurs before, during or after intercourse. It can be superficial (discomfort on initial penetration), deep (discomfort with deeper penetration) or both. This can happen with any gender but this description focuses on those with a vagina because it is more prevalent in that population. It can occur for a variety of reasons- many of which can be addressed with pelvic floor Physical Therapy. Some contributing factors include vaginal dryness, menopause, vaginismus, emotional stress/trauma, pelvic organ prolapse, endometriosis or anothe pelvic pain condition.
Vestibulodynia
Vestibulodynia is chronic pain and discomfort that occurs in the area around the opening of the vagina, inside the inner lips of the vulva. This area is known as the vestibule. The pain may occur when the area is touched, when a tampon is used, during sex, during a pelvic exam, when tight clothes are worn, or even when sitting for a long time. In some cases the area may also be red and inflamed. Vestibulodynia is a specific type or localized form of vulvodynia, chronic pain of the vulva. The exact cause of vestibulodynia is not yet known however it appears to be the result of hypersensitive nerve endings or an overgrowth of nerve fibers in the vestibule area of the vulva. Factors that may contribute to or exacerbate vestibulodynia include Chronic yeast infections, injury or trauma including sexual abuse and childbirth, sensitivity to irritants in detergents, soaps, douches and panty liners, or damage or irritation of the nerves of the vulva .Treatment varies but may include avoiding behavior modifications like avoiding irritants such as tight-fitting clothing, perfumes, and dyes, activity modification, pelvic floor muscle relaxation or desensitization, stretches for the pelvic floor muscles and surrounding structures, nervous system downregulation, etc. should also be avoided.
Coccydynia/Tailbone pain
Coccydynia is pain in the area of the coccyx or tailbone. Sometimes tailbone pain is directly related to an injury like a fall or trauma during birth. Other times it begins due to an indirect cause such as tightness in pelvic floor muscles, poor posturing, poor mobility or increased sensitivity of nerves that supply the area, fascial restrictions, constipation, etc. Pelvic floor Physical Therapy can help! Treatment may include activity modifications, seating modifications, addressing constipation, pelvic floor muscle relaxation or stretching, manual therapy to surrounding structures in the hips and low back, stretches and exercises.
Rectal Pain
Rectal pain is pain or discomfort in the lower portion of the gastrointestinal tract. The term is often used interchangeably with pain in the anus or anal pain. It is a fairly common problem and can result from conditions such as hemorrhoids or anal fissures. Rectal pain can be associated with prolapse, inflammatory bowel diseases, and in rare cases cancer. Once medical causes are ruled out by your doctor, two common causes remain that are musculoskeletal in nature and can be treated by a pelvic floor physical therapist. Levator syndrome, also known as levator ani syndrome, is a spasm of the levator ani muscle that causes fleeting pain in the rectum. Proctalgia fugax is another term that refers to rectal pain occurring from muscle spasm.
