CAUSES OF PELVIC PAIN & PAINFUL SEX IN PEOPLE WITH UTERUSES

Kim Vopni is a certified fitness professional, an author, a passionate speaker, and a women’s health educator. Her most recent book Your Pelvic Floor launched in March 2020 and was on the bestseller list since pre-orders launched in January. Kim is the founder of Pelvienne Wellness Inc and certifies other fitness and movement professionals to work with women with core and pelvic floor challenges through her Core Confidence Specialist Certification and Pre/Postnatal Fitness Specialist Certification. You can find her on-line at www.vaginacoach.com and on social media @vaginacoach

It is reported that between 14% and 32% of women of childbearing age experience chronic pelvic pain. Pelvic pain is complex, poorly understood and as a result is often difficult to manage because there are so many different conditions and causes. Having a collaborative multidisciplinary health care team is ideal but not everyone has access to this which further compounds the issue. 

QUICK LINKS:

1. What Causes Chronic Pelvic Pain?

2. Common Contributors of Pelvic Pain

3. How to Treat Chronic Pelvic Pain

What Causes Chronic Pelvic Pain?

Pelvic pain can be caused by pelvic floor dysfunction but can also be the cause of pelvic floor dysfunction. Chronic pelvic pain can interfere with our mental health, our physical health, and our emotional health which decreases our overall quality of life. Understanding the most common contributors can be a good starting point for seeking care.

Common Contributors of Pelvic Pain

Vulvodynia

Pain in and around the vulva that has no identifiable cause and lasts 3 or more months is termed vulvodynia. Common symptoms include burning, stinging and throbbing sensations that can make sitting uncomfortable, certain clothing items off-limits, and may make sex unthinkable. The pain can be constant or it can come and go. The pain can be generalized which is felt without touch or it may be pain only with touch which is called provoked vulvodynia or vestibulodynia if the pain is at the entrance to the vagina.

Yeast and bacterial infections as well as skin conditions can contribute to vulvodynia and it is important to seek the guidance of a gynecologist- however you may also be referred to a dermatologist, neurologist, and/or physical therapist.

Treatment may include diet and lifestyle modifications, oral medication, topical medication, nerve blocks, physical therapy, and even surgery for those who are dealing with provoked vestibulodynia.

Vaginismus

Vaginismus is a condition that presents with some of the same symptoms as vulvodynia such as burning and irritation, however, in vaginismus, the vagina tightens and may even close which makes penetration impossible. Primary vaginismus is when the symptoms occur prior to the onset of puberty whereas secondary vaginismus occurs later in life such as after childbirth or a trauma.

Vaginismus, like vulvodynia, is treatable and having a collaborative health care team is helpful. Treatments can range from diet and lifestyle approaches, to muscle relaxants and Botox. There is unfortunately not a standard treatment that is successful for everyone so an individual approach is best.

Pelvic Floor Dysfunction

Vulvodynia and vaginismus can often be grouped under the category of pelvic floor dysfunction. Dyspareunia (painful sex), tailbone pain, pubic joint pain, and low back pain can also be considered types of pelvic floor dysfunction. The pelvic floor is a group of muscles that close off the base of the pelvis and attach to the tailbone, pubic joint, and 2 sitz bones. When working well, they manage our continence, support our internal organs, stabilize the spine and pelvis, and contribute to sexual response. When not working optimally, conditions such as those mentioned above are common along with incontinence, organ prolapse, constipation and urinary retention.

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Pelvic floor physical therapy is the recommended first line of defense for pelvic floor dysfunction and can be a life changing therapy. We need our pelvic floor to have strength, endurance, and suppleness. When muscles are non-relaxing or unable to let go of tension, pelvic floor therapists can use manual techniques to help the muscles relax. When muscles are too lax, pelvic floor therapists can help guide you through exercises to strengthen the muscles. Many pelvic health professionals recommend we care for our vulvovaginal health like we do our oral health and proactively visit a pelvic floor physical therapist once a year for a check-up and more if treatment is needed.

Vaginal Atrophy/Dryness

Genitourinary Syndrome of Menopause is a newer term used to describe the changes to the vulva and vagina that occur around the onset of menopause. The tissues in the vagina become thinner and drier. The walls of the vagina narrow and urinary incontinence increases. This is a result of the loss of estrogen and while most commonly associated with the end of menstruation, it can also occur in people who have recently given birth. Wearing incontinence pads can also contribute to vaginal dryness, as can PCOS.

Local vaginal estrogen is extremely safe and very effective for vaginal dryness.  Hyaluronic Acid based vaginal moisturizers are also safe and effective.  Penetrative sex with or without a partner can help prevent the walls of the vagina from narrowing and can help maintain blood flow and circulation which is important for lubrication. Pelvic floor exercise also helps improve and maintain blood flow while also helping strengthen the muscles which can help prevent and overcome incontinence.

Pelvic floor physical therapy can help ensure the muscles are working in a balanced way while your medical doctor or naturopathic doctor can help you with the local vaginal estrogen prescription.

Endometriosis

There has been a welcomed increase in awareness about a common condition called Endometriosis which occurs when uterine-like tissue is found outside of the walls of the uterus. A similar condition, Adenomyosis, is when uterine-like tissue grows into the muscular wall of the uterus. Both conditions can contribute to extreme cramps, pelvic pain, pain with ovulation, heavy bleeding and fatigue.

There is no cure for endometriosis.  It is suggested that the only cure for Adenomyosis is a hysterectomy, however many have used diet and lifestyle strategies to overcome the condition.

Working with a pelvic floor physical therapist is strongly recommended. They can help ensure the muscles continue to work optimally. They can also help ensure that scar tissue from surgeries does not interfere with muscle function and becomes another source of discomfort. Many have found symptom relief through Chinese Medicine, Acupuncture, Yoga, Nutritional Therapy and Functional Medicine.

Lichen Sclerosus

When discussing pelvic pain, we need to also consider the skin surrounding the vulva as well. Lichen Sclerosus is a fairly common, chronic inflammatory skin disorder that affects the genital area and can occur in those with female and male anatomy. There are patches of white skin that are thinner than other parts and can be a source of burning, itching and tearing, especially during penetrative sex. Topical steroids are the most common treatment and products such as vaginal dilators can also be used to help facilitate pain-free sex.

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Painful Sex

The term for persistent or recurrent pain with sex is called dyspareunia and is characterized by pain just before, during or after intercourse. The pain can be felt on the external surfaces or deeper inside closer to the cervix. Many of the above conditions can contribute to dyspareunia but other things like cancer, pelvic surgery, childbirth and even hormone deficiency can contribute to it as well. When the root cause is known, finding the best treatment option is facilitated, which may include treating a UTI, physical therapy to help with organ position and muscle function, and vaginal estrogen and/or vaginal moisturizers to help with hormone changes.

How to Treat Chronic Pelvic Pain

Chronic pain, especially in the pelvis, can interfere with one’s quality of life, however there are so many treatment options available that can provide relief, hope and resolution to those who suffer. Pelvic floor physical therapy is a common thread throughout and is often the missing link for many who have been suffering for extended periods of time. To find a pelvic floor physical therapist near you, you can google pelvic floor physical therapy and your city.  You can also visit the Physical Therapy Association in your country and look under women’s health professionals.

Further Readings:

5 Penis Bumper Toys That Help Make Sex Pain-Free: Well + Good
8 Sex Toys for People with Endometriosis: Cosmopolitan
How to Use Kegel Weights: Pixie Cup

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