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Does my pelvic girdle pain have anything to do with my mood and sexuality?
Many of our patients experience sexual dysfunction and anxiety, depression and chronic pain. These conditions are known to coexist, and we unpack each component of pain, mood and one’s behaviors, desires and attitudes related to sex and physical intimacy.
Pelvic girdle pain is defined as “pain between the posterior iliac crests and gluteal folds particularly in the vicinity of the sacroiliac joint” (Simonds). More simply stated: in the very low area of your back and buttock. Pelvic girdle pain is common postpartum and may impact disability in the fourth trimester. Many are aware of peripartum symptoms such as low back pain, incontinence, pelvic organ prolapse, pain with intercourse, and postpartum depression. Knowing that many women experience pain during and after pregnancy - what can we learn about the effects of pelvic girdle pain? Specifically, what impact does pelvic girdle pain have on symptoms of mood and sexuality?
Studies report about 20% of women suffer from pelvic girdle pain during pregnancy and most recover from this pain within 3-6 months after childbirth. However, anywhere from 16%-31% can continue to suffer from persistent pain in the pelvis. Persistent, or chronic pain is usually defined as pain that does not resolve beyond 3-6 months. The more severe the pain is during pregnancy, the higher the likelihood of pain after childbirth. (Rexelius et.al.) There is a complex interplay between pain and emotions, and pelvic girdle pain follows a similar story with it’s effect on mood and feelings of sexuality after labor and delivery.
There is an interrelationship between our emotional status and pain perception. (Roy et.al.) It is understandable that pain can elevate negative emotions like anxiety and depression particularly in an emotional and possibly turbulent time such as pregnancy or postpartum. Whenever we have pain, feelings of anxiety or depression can arise, and this certainly holds true for pelvic girdle pain as well. There are a variety of tissues where pain in the pelvis may originate from, making it more complex to treat; joint, ligament, muscle, fascia as well as nerves - both peripheral (nerves that lie outside of your brain and spinal cord and communicate to and from tissues) and central (nerves that communicate within the spinal cord and brain).
Studying postpartum women with and without pelvic girdle pain along with their experiences with sexuality and mood changes has given us more information, but also left us with more questions.
Some studies show a link between pelvic girdle pain and sexual dysfunction. This study attempted to break down aspects of “sexual function” and found no significant difference in depression between those with and without pelvic girdle pain. Although pelvic floor strength was similar between groups, those with pelvic girdle pain had more pain with intercourse, suggesting that those with pelvic girdle pain had tension and tenderness and they likely avoided intercourse to evade a negative sexual experience as a protective response. (Rexelius) Regarding sexual satisfaction, women were less satisfied regardless of the presence of pain during pregnancy. At 6 months postpartum, those with pain had similar satisfaction sexually than those without pain, but had not yet returned to pre pregnancy satisfaction levels. By the 12 year mark most women were satisfied with their sex lives. (Mogren) The suggestion was that the longer someone had pain, the more likely they were able to find coping strategies for their pain. Although pain seems to affect satisfaction with their sex lives, it hasn’t been shown to lower desire, arousal and orgasm.
So what does it all mean? Ultimately, we know each person’s experience is uniquely theirs and each person’s treatment must be tailored to their specific needs. Each therapist at Fusion Wellness/Femina PT will assess your physical needs while keeping in mind your experience and expectations to help you develop coping strategies, build resilience and meet your intimacy goals.
References
Rexelius, N., Lindgren, A., Torstensson, T. et al. Sexuality and mood changes in women with persistent pelvic girdle pain after childbirth: a case-control study. BMC Women's Health 20, 201 (2020). https://doi.org/10.1186/s12905-020-01058-7. https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-020-01058-7
Simonds, Adrienne H. PT, PhD1; Abraham, Karen PT, PhD2; Spitznagle, Theresa PT, DPT, WCS3. Clinical Practice Guidelines for Pelvic Girdle Pain in the Postpartum Population. Journal of Women's Health Physical Therapy 46(1):p E1-E38, January/March 2022. | DOI: 10.1097/JWH.0000000000000236 https://journals.lww.com/jwphpt/fulltext/2022/01000/clinical_practice_guidelines_for_pelvic_girdle.9.aspx
Mathieu Roy, Mathieu Piché, Jen-I. Chen and Pierre Rainville
