Chronic Overlapping Pelvic Pain Conditions

Are You Suffering From Chronic Overlapping Pelvic Pain Conditions? We Can Help!

Part 1: Endometriosis and Vulvodynia

Chronic pelvic pain, sometimes abbreviated to “CPP”, is defined as “pain in the abdomen or pelvis for at least 14 days per month and severe enough to cause functional limitations” by a recent literature review of chronic pelvic pain⁵. The cause of chronic pelvic pain is often multifactorial and can be the result of conditions such as:

• endometriosis
• Vulvodynia (or vestibulodynia)
• interstitial cystitis/bladder pain syndrome
• irritable bowel syndrome (IBS)

Many times, patients who suffer from chronic pelvic pain often suffer from other chronic pain conditions as well including^5,3,4:

• Fibromyalgia
• temporomandibular disorders (TMJD)
• migraine headaches
• chronic tension headaches
• chronic low back pain
• myalgic encephalomyelitis/chronic fatigue syndrome
• complex regional pain syndrome or “CRPS”

In part one of this series, we will focus on endometriosis and vulvodynia and how the two conditions can be interrelated. First, we will briefly describe each condition:

Endometriosis: Endometrial-LIKE tissue is present outside of the uterus. This can be anywhere in the body, but most commonly seen in the pelvic peritoneum, ovaries, fallopian tubes, rectum, colon, bladder, or appendix. Symptoms of the disease vary person to person, but may include: painful periods, non-cyclic pelvic pain, painful sex, painful urination, pain with bowel movements/difficulty with bowel movements (dyschezia), and infertility. Often the diagnosis is delayed, due to the overlapping symptoms with many other health conditions, and to get a formal diagnosis requires confirmation via laparoscopic surgery.³

Vulvodynia: defined as persistent vulvar pain, meaning in the external genital tissues, present for at least three months. It can be provoked by contact or spontaneous. Symptoms can include: burning, stinging, general irritation, and a less common symptom of vulvar itching. Painful sex, or commonly seen as dyspareunia, can often be caused by vulvodynia.⁴

In both of these conditions, there is an increase in nerve fiber density surrounding the affected tissues, oftentimes creating pain with sex either at the entrance of the vagina/external genitalia (vulvodynia) or deeper penetrative pain (often due to endometriosis and termed deep dyspareunia), or both^3,4. On top of the increased nerve fibers, pain processing becomes distorted over time due to phenomena called central sensitization, peripheral sensitization, and cross sensitization. This is when the nervous system becomes overly sensitive to pain signals, and can lead to inappropriate firing of neurons in other regions of the body, away from the original injury or pathological source. Check out this article on our website explaining this mechanism in further detail.

Recent evidence has shown early treatment of endometriosis and vulvodynia can decrease risk of the development of chronic pain and central sensitization¹. In order to be successful in managing chronic pelvic pain, it is essential that care is multidisciplinary, which includes addressing the musculoskeletal contributors of pain in both endometriosis and vulvodynia. It has been estimated that among patients with chronic pelvic pain, 60-90% have musculoskeletal dysfunction contributing to their pain^2,6. Pelvic floor PT can make a huge difference in quality of life by helping to manage symptoms due to muscle tension and nerve pain. 

At Femina Physical Therapy, all of our physical therapists have specialized training to address the musculoskeletal components of your pain and will work with your other healthcare providers in a collaborative manner to maximize symptom-relief and improve your quality of life. Whether you are experiencing chronic overlapping pelvic pain conditions or just want to take preventative measures to ensure they don't get worse, feel free to reach out to our team to get started.

Resources:

1. Allaire C, Bedaiwy MA, Yong PJ. Diagnosis and management of endometriosis. CMAJ. 2023;195(10):E363-E371. doi:10.1503/cmaj.220637

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10120420/

2. Fitzgerald CM, Neville CE, Mallinson T, Badillo SA, Hynes CK, Tu FF. Pelvic floor muscle examination in female chronic pelvic pain. J Reprod Med. 2011;56(3-4):117-122.

https://pubmed.ncbi.nlm.nih.gov/21542528/

3. McNamara HC, Frawley HC, Donoghue JF, et al. Peripheral, Central, and Cross Sensitization in Endometriosis-Associated Pain and Comorbid Pain Syndromes. Front Reprod Health. 2021;3:729642. Published 2021 Sep 1. doi:10.3389/frph.2021.729642

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9580702/

4. Mwaura AN, Marshall N, Anglesio MS, Yong PJ. Neuroproliferative dyspareunia in endometriosis and vestibulodynia. Sex Med Rev. 2023;11(4):323-332. doi:10.1093/sxmrev/qead033

https://pubmed.ncbi.nlm.nih.gov/37544766/

5. Till SR, Nakamura R, Schrepf A, As-Sanie S. Approach to Diagnosis and Management of Chronic Pelvic Pain in Women: Incorporating Chronic Overlapping Pain Conditions in Assessment and Management. Obstet Gynecol Clin North Am. 2022;49(2):219-239. doi:10.1016/j.ogc.2022.02.006

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9297339/

6. Sedighimehr N, Manshadi FD, Shokouhi N, Baghban AA. Pelvic musculoskeletal dysfunctions in women with and without chronic pelvic pain. J Bodyw Mov Ther. 2018;22(1):92-96. doi:10.1016/j.jbmt.2017.05.001

https://pubmed.ncbi.nlm.nih.gov/29332764/