Pelvic and urogynecological pain disorders are by no means rare. In fact, 50 percent of all U.S. women have female sexual dysfunction, according to the medical journal Urology.¹Sexual dysfunction affects 43 percent of U.S. women aged 18 to 59, reports the Journal of the American Medical Association.²Despite this prevalence, it is still hard for patients to find help for these disorders. "Most doctors don't even ask about pelvic or sexual pain which makes it even harder for the patient to bring up," explained Amy Stein, MPT, BCIA-PMDB, owner of Beyond Basics Physical Therapy, New York, NY.

Patients may also feel embarrassment, Stein mentioned. Some patients are too uncomfortable to talk about their pelvic pain-even with health care providers who specialize in treating the condition. "Usually, though, by the time they get to us they feel a little more comfortable talking about it," said Stein, author of Heal Pelvic Pain.

Those who come to Beyond Basics Physical Therapy have typically had pelvic pain for a long time, she noted. "It can happen as early as childhood or it can develop later in life."

No matter when the pain starts, physical therapists who specialize in treating pelvic and urogynecological pain disorders can help diagnose and treat this population.

Diagnosis

Intercourse isn't the only activity that leads to pain in this population. Belinda Wurn, PT, national director of services for Clear Passage Therapies^® based in Gainesville, FL, noted that some patients with vulvodynia (chronic vulvar pain without an identifiable cause) and other urogynecological disorders report pain in the back, hip or with activities associated with using the lower extremities, especially the gluteal or adductor muscles.

"Some patients that we treat report tailbone pain and difficulty or inability to sit," said Wurn, author of Miracle Moms, Better Sex, Less Pain.

A number of health care providers believe that vulvodynia and dyspareunia (painful intercourse) can be triggered by vaginal yeast infections, gynecologic surgery or childbirth. These conditions have also been associated with sexual abuse.

Stein remarked that pelvic and urogynecological disorders are more commonly diagnosed now than years ago and mentioned there has been a significant jump in International Pelvic Pain Society (IPPS) members from when she joined seven years ago. Hundreds of MDs, physical therapists, nurses, mental health providers and other health care providers make up the IPPS membership. Still, many patients are undiagnosed for years, leaving them frustrated and psychologically distressed.

"The emotional pain of the inability to have sex, or pain-free intercourse can be totally devastating," noted Wurn. "This condition robs women of their lives, and of intimacy in life. The inability to be intimate too often makes women think of themselves as 'not whole.' Many women describe the total failure of marriages or relationships, abject loneliness, and the inability or unwillingness to pursue another relationship."

Stein concurred. "[The emotional toll] is pretty significant," she said. "We've had patients talk about suicide. They don't feel their life is worth living anymore."

Pelvic and urogynecological disorders are complex to diagnose in part because of the comorbidities that exist, noted Stein. She sees many patients with irritable bowel syndrome and interstitial cystitis, in addition to vulvodynia or vaginal pain.

Treatment

Western medicine's usual responses to pain are to administer pharmaceuticals or schedule patients for surgery, remarked Wurn. However, surgery is not an appropriate treatment for the diagnoses of dyspareunia and vulvodynia.

"The best that physicians have been able to offer this patient population are pain relievers to mask the pain, or desensitizing agents to decrease sensation. Clearly, most women do not want to be deprived of sensation in an area designed to create some of life's greatest pleasures, by numbing the most sensitive tissues in their bodies," she said.

Patients desire an effective therapy to address the cause of their pain or spasm; this is where physical therapists come in.

Wurn noted that she can only speak about her clinic when saying the physical therapist's role in treating urogynecological pain disorders is to totally eliminate the pain and any spasm in two main ways.

"We manually address any biomechanical dysfunction in the osseous and soft tissue structures of the pelvis and their attachments (above, into the abdomen and pelvis, and below, into the lower extremities).

"We also address any and all adhesive patterns that have formed due to healing events earlier in life. Whether these adhesions have formed at the coccyx, cervix, perineum, pelvic floor or on the vaginal walls, we use specialized soft-tissue techniques we have developed over the past 20-plus years to decrease adhesions and increase soft tissue mobility throughout the urogenital system."

To reduce pain, Wurn instructs patients to perform the following stretches: adductor, hamstring, quads, perineal, double knee to chest and piriformis. Any stretch that decreases unusual pulls on and within the urogenital system and hips works, Wurn commented. She also teaches patients specific techniques for self-treating internally.

Stein mentioned that treatment involves quite a bit of manual therapy techniques, such as myofascial, trigger point and deep tissue release.

"You also have to do neuromuscular re-education. A lot of these patients are using their muscles incorrectly. Instead of relaxing the muscles when they go to the bathroom, they are tensing the muscles. With intercourse, women may be tensing the muscles instead of relaxing the muscles. This can be treated manually as well as with biofeedback," she observed.

With treatment, many patients with sexual pain or dysfunction will experience decreased or eliminated pain. The future has much to offer this population, concluded Wurn. In her published studies and citations multiple sexual function and pain level improvements are noted, including 96 percent of sexual function study participants who reported reduced sexual intercourse pain.³

Find more information here: http://www.vaginismus.com/ 

References

1. Basson, R., Berman, J., Burnett, A., et al. (2000). Report of the international consensus development conference on female sexual dysfunction: Definitions and classifications. Journal of Urology, 163, 888-893.

2. Laumann, E.O., Paik, A., et al. (1999). Sexual dysfunction in the United States: prevalence and predictors. JAMA, 281, 537-544.

3. Wurn, L., Wurn, B., King, C., et al. (2004). Increasing orgasm and decreasing dyspareunia by a manual physical therapy technique. Medscape General Medicine, 6(4).

Beth Puliti is senior associate editor and web editor of ADVANCE and can be reached at epuliti@advanceweb.com