Persistent Pelvic Pain

Persistent Pelvic Pain is often a secondary effect from conditions such as:

  • Dysmenorrhea, commonly known as painful periods, is often associated with various conditions, including:
    • Endometriosis
    • Adenomyosis
    • Polycystic Ovary Syndrome (PCOS)
  • Emotional trauma resulting from non-consensual contact or childbirth experiences
  • Vaginal trauma, such as perineal tears
  • Scar tissue from procedures like abdominal surgery or cesarean deliveries

Symptoms

 

Chronic pelvic pain can manifest as discomfort in the lower abdomen, perineal pain, dyspareunia (pain during penetration), or vaginismus (a muscle spasm that prevents penetration and often causes pain).

It may present as sensations of burning, scratching, deep aching, spasms, tearing, pulling, or stinging. This pain can be associated with sexual activity like penetration, as well as everyday functions such as urination or defecation. It can also occur after the activity, and can persist from minutes, to days.

 

Assessment and Treatment of Persistent Pelvic Pain

As persistent pelvic pain is often a secondary problem, so it is important to explore your history in order to identify the potential primary problem. Understanding this relationship helps us address the pain you're experiencing and determine if further evaluation is necessary. This may involve referrals to specialists such as your GP, gynecologist, or colorectal specialist for additional insights or imaging. You might have already consulted a specialist and are here following previous diagnoses.

Effective treatment begins with a comprehensive assessment. We will review your history, covering essential topics like bladder and bowel function, menstrual cycles, sexual health, obstetric history, gynecological background, and overall medical history. With your consent, a pelvic examination will include evaluating both the external vaginal opening and the internal vagina. Typically, this assessment involves a digital examination to assess pelvic floor muscle health, cervix positioning, and the strength, tension, and coordination of your pelvic floor. At times, I may seek your consent to use a speculum for a detailed examination of the internal vaginal walls.

Recognising that you have a pain syndrome, I will be looking to identify the source of your discomfort, while ensuring the assessment process is as comfortable as possible. After the evaluation, we will discuss my findings and explore suitable treatment options for your consideration.

Treatment will be tailored to your specific presentation, typically focusing on pelvic floor muscle down-training through contraction-relaxation techniques, breathing exercises to enhance abdominal mobility, and stretching programs. Additional treatment methods may include modalities such as Thile massage of the pelvic floor, perineal massage, scar massage, the use of dilators, wands, and e-stim therapy, among other options, all customised to address your individual needs. If you are also experiencing bladder or bowel dysfunction, we will incorporate strategies to address those issues as well. Sometimes, a musculoskeletal approach may be necessary, focusing on the areas around, above, and below the pelvis.