Different types of pelvic pain

Vulvodynia is a term that simply means pain in the vulvar region, which includes the pubic area, the outer and inner labia, the clitoris, and the urethral and vaginal openings.  Pain can occur in different locations around this region either due to skin sensitivity, irritation to the bladder or urethra, overactive pelvic floor muscles, scar tissue, or myofascial restriction.  There may be sensitivity to sitting or wearing tight clothing.  Pain may also occur during specific times at the start, during, or after intercourse.  Your therapist can help to determine which structures are generating pain and how to problem solve how to reduce irritation to these region with discussion on activity modifications, postural modifications, bladder habit re-training, pelvic floor stretches, and pelvic floor strengthening exercises.  

Vaginismus is an involuntary muscle spasm of the pelvic floor muscle upon insertion whether this be from devices such as a tampon or speculum, or pain with intercourse. This may occur in isolation or in conjunction with vulvodynia.

Pelvic Floor Muscle Pain may also occur internally due to tender points and muscles holding extra tension or tone at rest. This can occur due to emotional stress, low back or hip pain and dysfunction, abdominal and pelvic scar tissue, tailbone injuries, as well as painful periods or endometriosis. Treatment can include manual therapy, instruction in self-release, as well as breathing exercises, and addressing other driving musculoskeletal factors.

Endometriosis/Painful Periods or Ovulation Endometriosis is uterine like tissue that develops outside of the uterus creating scar tissue to surrounding organs.  Symptoms create significant pain during menstruation. Pain from this condition as well as just general notable period pain can trigger pelvic floor muscle guarding and pain.

Referred pain from the spine, hips, low back, and surrounding nerves can be felt in the pelvis. Furthermore, pain in these regions can also be referred from the pelvic floor. If you have chronic low back or hip pain, pelvic floor physical therapy may be a missing piece of the puzzle!

When do I consult with another medical provider?

If your therapist determines you are showing signs and symptoms of an active infection through visual inspection or from your history, they may ask you to see your gynecologist or urogynecologist prior to continuing with rehab.  It is important you are addressing or managing (with your provider) any active infections prior to coming to physical therapy. 

There are also circumstances where you are coming to physical therapy and managing your condition with prescribed medication.  For instance, estrodial cream may be ordered to help the healing process and make the tissue more elastic. This will be decided on with your urogynecologist or gynecologist.  Before using any time of moisturizer or medication, consult your doctor first.