For years, women have suffered in silence from pelvic pain, often not even discussing the problem with their physician. Others visit numerous health care practitioners desperately seeking answers about the source of their pain. The pain they experience can affect their ability to work and perform daily living activities. It can also affect relationships with spouses or significant others. Many women avoid sexual relations because of pain. Worse yet, many feel that no one can help them.
Chronic pelvic pain can present itself in numerous ways. Symptoms may include:
Lower abdominal pain
Painful sexual intercourse
Itching or burning around the vagina or pelvic floor (may have diagnoses of frequent yeast infections)
Pain in the bladder or rectal areas (may have diagnosis of interstitial cystitis)
Painful clitoral area and/or inability to achieve orgasm
Lower back pain
Sometimes these symptoms can be related to endometriosis, ovarian cysts, or other medical problems. Symptoms may be as a result of a yeast infection, but this diagnosis can be inaccurate. In other instances, the woman has undergone numerous diagnostic procedures including laparoscopy, and the source of the pain remains unknown. That’s where a relatively new area of physical therapy can help. A physical therapist specially trained in women’s health can assist with pain relief and return a woman to a more normal level of functioning, whether it be normal bowel and bladder function or pain-free sexual intercourse.
A women’s health physical therapist can evaluate the pelvic area from a muscular, skeletal and nerve standpoint. The physical therapist may find that muscles are in spasm, the spine or pelvis may be positioned incorrectly, and nerves may be irritated or not functioning correctly which all result in pain and dysfunction.
I very frequently see women in my clinic who have complaints of painful sexual intercourse. This can be devastating to a relationship. The woman often feels as if it’s her fault, in some way, that she experiences pain with sex. Her partner doesn’t understand the problem and becomes frustrated. This can lead to diminished sexual interest or avoidance altogether. However, this problem can be treated very effectively. The spine is evaluated for abnormalities, irritated nerves are calmed and muscles are gently stretched back to normal lengths. After the physical problems are cared for, the couple may need additional help from a behavioral therapist specializing in sex therapy in order to complete the healing.
A women’s health physical therapist can also help a women who has a diagnosis of interstitial cystitis. Interstitial cystitis can include a variety of symptoms and the cause is unknown. Women with this diagnosis have inflamed bladder walls, bladder or pelvic pain and pressure which can be intense, and the need to urinate very frequently, often with urgency. These symptoms can worsen during their menstrual cycle and most complain of pain with sexual intercourse. Medications are not very effective in controlling this problem. Again, physical therapy is efficacious in fighting these symptoms. Evaluation of women with this diagnosis can reveal long-term lower back pain which is not always severe in nature but causes nerve irritation. The lower back pain can be treated, which decreases the nerve irritation. Other elements of treatment include bladder and pelvic floor muscle re-training.
The important thing to remember is that chronic pelvic pain and its variety of symptoms can be effectively treated with physical therapy. Recent studies show that a manual physical therapist that specializes in pelvic floor dysfunction can relieve discomfort, and improve muscle and bowel and bladder function. Women don’t have to live with pain nor is it “all in your head” when you experience pain with sexual intercourse. There are physical reasons for your pain! If you are experiencing symptoms of chronic pelvic pain, I encourage you to consult with a women’s health physical therapist to evaluate your needs and move towards recovery.
Pam Palmer PT
Women’s Health Physical Therapist
Palmer Physical Therapy for Women