by Alexandra T. Milspaw and Robert J. Echenberg

 

Chronic Pelvic Pain (CPP), often associated with chronic sexual pain, is one of the most complex, misunderstood, torturous and undiagnosed experiences in the field of sexual medicine. CPP interweaves physical, mental, emotional and spiritual suffering for millions of women around the world. CPP can be linked to vulvar pain, chronic vaginal itching and sensitivities, fibromyalgia, low back pain, migraines, irritable bowel syndrome (IBS), endometriosis and bladder disorders such as Interstitial Cystitis (IC).

The effects of chronic pelvic and sexual pain branch out into all aspects of women’s lives, including, but not limited to, their work and home environments, their familial and sexual relationships and their ability to maintain their quality of life. When treating CPP and associated sexual dysfunctions, it is critical to have an integrative approach involving the whole woman’s health. One of the main goals of the Institute for Women in Pain is to offer a multidisciplinary approach for the treatment and management of chronic pelvic and sexual pain.

Chronic pelvic and sexual pain has been researched and documented for decades. In the past 10 years, the research on chronic pain has exploded. We are applying this new research, which focuses on the importance of multi-disciplinary care, to the pelvic area of the body. With CPP, it is critical to treat all triggers of the pain simultaneously, rather than one at a time. These triggers often include the bladder, bowel, reproductive organs, muscles, ligaments, nerves and the “neuro-matrix,” which is the map the “pain” signal follows once it reaches the brain. Regretfully, in the world of research, it takes many years for this information to trickle down to the practices of most doctors and practitioners who are seeing these symptoms on a daily basis. 

CPP affects one out of every five or six reproductive-aged women in America. Therefore, we promote the importance of education for both providers and patients in order to prevent early-onset symptoms from snowballing into the epidemic of chronic pelvic and sexual pain.

It is crucial to inform all practitioners on the complex symptoms involved with CPP in order to start the treatment and management as early as possible, as well as to prevent the multiple surgeries and visits to the emergency room that often occur. Many of these symptoms, such as urinary urgency, frequency and discomfort, are easily identifiable as early as middle school and high school. Furthermore, a correlation between female athletic injuries and CPP diagnoses is being discovered; therefore, spreading the word to athletic departments, coaches and parents to keep an eye out for these symptoms is also important.

A comprehensive medical evaluation and history review can help determine appropriate treatment modalities, which may include mindfulness-based stress reduction, myofacial release and massage, reflexericse, embodiment therapy, Svaroopa yoga and more.

Stress management and mind/body relaxation can be effective throughout the entire treatment process. Most women suffering from chronic pelvic and sexual pain report difficulty falling asleep and staying asleep for more than two or three hours at a time due to both the constant stabbing and burning sensations as well as muscle spasms and resultant clenching of the “core.” Mind/body relaxation techniques can help individuals redirect their minds away from the pain, expanding their awareness and re-focusing on a more peaceful sensation, thought or memory. This not only helps them fall asleep, but also helps them stay asleep. Allowing their bodies to have a full night’s rest permits the rejuvenation of the mind and the physical body, which in turn provides much-needed energy for the body to begin the healing process.

Often, the sheer mental and physical exhaustion of chronic pain restricts the body’s natural ability to heal itself. If a woman truly believes that she will never get better, then the body will react accordingly. However, as hopelessness dwindles, the body’s natural resources gain energy and the healing process begins. As research continues to show, the mind has unprecedented control over the physical body and cellular functions. When one is able to rewrite the script that plays repeatedly in their mind regarding their hope and ability to regain health and wellness, one can literally rewrite the script their brain is playing on their cellular body and physical sensations.

Dr. Robert Echenberg is the medical director of Women’s Health, Pelvic Pain & Sexual Wellness and the Institute for Women In Pain. Alexandra Milspaw is the executive director of the Institute for Women in Pain. For more information call 610-868-0104 or visit InstituteForWomenInPain.org.