WHAT CAUSES IT?There are many excellent websites dedicated to providing information on the various causes of chronic pelvic pain. Some of these causes and the websites are listed below.
PUDENDAL NEURALGIA, NEUROPATHY AND NERVE ENTRAPMENTDisorders that involve compression or restriction in mobility of the pudendal nerve along its pathway and causing pain may be called pudendal neuralgia or where the nerve is truly entrapped it may be diagnosed as an entrapment. These are quite rare. Sometimes the pudendal nerve is involved in chronic pelvic pain conditions and sometimes it is diagnosed as being involved where it is not the main cause of the pain. More on pudendalhope.info
VULVODYNIAIt is a term used to describe vulval pain. It is a generic term and there is a further sub-classification depending on how the pain in the vulva is provoked. This depends on whether it is with provocation or is permanently present. Typically the skin is very sensitised. There may or may not be involvement of the pudendal nerve as well and the two conditions are often confused and need to be evaluated differently. More on vulvalpainsociety.org National Vulvodynia Association nva.org and issvd.org
VAGINISMUSVaginismus is a condition where the pelvic floor muscles have become so tense that penetration with intercourse or even the use of a tampons are impossible or at least very painful. It can be associated with vulvodynia (vestibulodynia) and or pudendal nerve conditions but can also present on its own. The cause is often unknown. It can take a long time for the muscle tension to ease out and dilators are often recommended as a treatment. They may or may not be helpful. It is important to know that assessment with an experienced physiotherapist may help in finding specific areas of restriction and therefore accelerate the process.
INTERSTITIAL CYSTITIS (IC) – Bladder Pain SyndromeThere is no definitive test for IC. The diagnosis is based on the presence of pain related to the bladder, usually accompanied by frequency and urgency of urine and in the absence of other diseases that could cause the symptoms.In response to the pain, urgency and frequency the pelvic floor muscles and abdomen become tense going into a holding pattern. The tension becomes part of the problem further feeding into the holding patterns and pain cycle. The pelvic floor muscles need to be able to control at the neck of the bladder. More about IC at ichelp.org
PAIN POST SURGERYVaginal tissue can be painful following any pelvic floor surgery. This should not be the case and intercourse should not be painful. It may be necessary for you to seek physiotherapy after your surgery even though your underlying problem has now been corrected by the surgery. In each of these cases the spine, pelvis and abdomen should be evaluated for posture and holding patterns. The pelvic floor muscles may have set up in tension in response to a specific posture, therefore they should be evaluated in detail.
OUR TREATMENT: Manual Therapy & ExercisesPelvic floor manual therapy and release exercises are a key part of treatment for pain conditions prior to any strengthening program. It is important to note that a multidisciplinary team approach is essential with chronic pain conditions. You can follow the exercise guide on this website – they will apply to everyone. If you are still struggling after a few weeks then you need the help of a physiotherapist who specialises in this area.
USEFUL INFORMATIONDownload our guide Overactive Pelvic Floor Muscles.doc
Interstitial Cystitis Association ichelp.org
The International Society for the Study of Vulvovaginal Disease issvd.org
NVA (National Vulvodynia Association) nva.org
Pelvic Floor rehabilitation website pelvicphysiotherapy.com
Health Organization for Pudendal Education pudendalhope.info
Vulvovaginal Disorders vulvovaginaldisorders.com