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Female Sexual Dysfunction and Chronic Pain Syndromes
Female sexual pain syndromes causing painful intercourse can occur for a number of reasons. A high percentage of women experience painful intercourse at some point in their lives.
Below you will find a number of articles that discuss the types of sexual pain syndromes that we treat. Click on any title or "Read More..." link for detailed info on each diagnosis.
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Endometriosis and Chronic Pelvic Pain
How Endometriosis can cause or contribute to chronic pelvic pain, and what pelvic floor therapy can do to help alleviate it
What is Endometriosis?
Endometriosis is a condition where endometrial-like tissue grows outside of the uterus (tissue that is similar to but not the same as endometrial tissue). The most common area for it to grow is in the abdominal cavity, where it can implant on the surface of other structures including the ovaries, bladder, rectum, and along the walls of the abdomen and pelvis, but it can be found anywhere in the body.
The true prevalence of endometriosis is unknown since it takes a laparoscopic procedure to confirm the diagnosis, and many women either have no symptoms or seek no treatment (Signorello, Harlow, Cramer, Spiegelman, & Hill, 1997). However, up to 78% of women undergoing laparoscopic investigation for infertility and up to 82% of women investigated for pelvic pain were found to have endometriosis in one study (Schenken, 1996; Wellbery).
Actress Lena Dunham has been vocal about her experiences with endometriosis, most recently publishing an essay in American Vogue on electing to have a total hysterectomy after years of chronic pain due to the condition. We want our readers to know that a hysterectomy is not a cure for endometriosis (since endometriosis is not a disease of the uterus). A hysterectomy is a cure for Adenomyosis, which is a type of endometriosis that is found in the uterus.
Read more: Physical Therapy for Endometriosis and Chronic Pelvic Pain
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Vaginismus Recovery is Possible
Is it painful to insert a tampon, get through a gynecological pelvic exam, or engage in intercourse? Have you always just thought maybe it’s just supposed to hurt and began to shy away from it all? You’re not alone. There are many women who have felt and thought the same things. What you are feeling is real and the culprit may be a condition called Vaginismus.
What is Vaginismus?
The definition of Vaginismus has been debated over the years and was first introduced into the Diagnostic and Statistical Manual of Mental Disorders (DSM), Third Edition in 1980. It was defined as a “recurrent or persistent involuntary spasm of the musculature of the outer third of the vagina that interferes with sexual intercourse”.1 And now in the DSM, Fifth Edition categorized as a disorder in which any form of vaginal penetration or insertion such as tampons, a digit, gynecological exams, vaginal dilators and intercourse is painful or impossible. Women have described it as “hitting a wall”. This disorder has been put under the umbrella of genito-pelvic pain/penetration disorder (GPPPD) in conjunction with dyspareunia (“recurrent or persistent genital pain associated with sexual intercourse”).2
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Painful Bladder Syndrome / Interstitial Cystitis:
This pain or discomfort is perceived to be related to the bladder upon filling or often immediately after emptying. Symptoms include urinary urgency with pressure, burning and aching pain along with increased frequency, > 8 times per day, and > 3 months duration.
Read more: Painful Bladder Syndrome | Interstitial Cystitis Symptoms
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What Does Vulvodynia Treatment Include?
Vulvodynia means “vulvar pain” or pain of the external female genital region. Symptoms include burning, stinging, and irritation of the tissues in this region. Light touch or pressure can cause severe pain with sitting, walking, riding a bicycle, and sexual intercourse. Vulvodynia is a general term, and there are many subtypes, including vulvar vestibulitis (inflammation of the vulvar vestibule), vestibulodynia (pain in the vulvar vestibule) and clitorodynia (painful clitoris).
Physical Therapy Treatments for Pelvic Pain Syndromes:
Most pelvic pain syndromes such as vulvodynia are related to overactivity of the pelvic floor muscles.
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Physical Therapy Treatments for Vulvar Vestibulitis Symptoms
What is Vulvar Vestibulitis/Vestibulodynia?:
Vulvar Vestibulitis/Vestibulodynia is a form of vulvodynia with tenderness specific to the vulvar vestibule. This occurs with pressure to the site causing pain at the vaginal opening with touch or attempted penetration (provoked vestibulodynia) or can also present as constant or frequent pain, irritation, or itching of the vulvar vestibule (unprovoked vestibulodynia). Tissues may also be red or swollen at times.
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Anorgasmia / Dysorgasmia - Orgasm Related Problems and Solutions
Anorgasmia and Dysorgasmia are clinical terms whose symptoms include complete lack of orgasm, diminished orgasms, and even painful orgasms. Causes can include physical, mental, and emotional factors.
Dysorgasmia / Painful Orgasms
Dysorgasmia is defined as a painful orgasm, but without any prior pain during sexual intercourse. The pain often manifests as a cramping sensation in the pelvis, buttock(s) or abdomen. The duration of pain from dysorgasmia can last from seconds to minutes to several hours.
Read more: Anorgasmia/Dysorgasmia - No Orgasms, Diminished Orgasms,...
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Dyspareunia:
From Wikipedia:
"Dyspareunia is painful sexual intercourse due to medical or psychological causes. The symptoms are significantly more common in women than in men. The pain can primarily be on the external surface of the genitalia, or deeper in the pelvis upon deep pressure against the cervix. It can affect a small portion of the vulva or vagina or be felt all over the surface. Understanding the duration, location, and nature of the pain is important in identifying the causes of the pain."
Vaginismus / Genito-Pelvic Penetration Disorder
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Vaginismus:
Involuntary muscle spasms involving the superficial and deep pelvic floor muscles that typically cause painful entry, limiting or preventing intercourse, tampon insertion or pelvic exams. Women with vaginismus do not always experience "pain" and often report the feeling of their partner or a tampon "hitting a wall".
Pain is also a common presentation when partial or complete penetration occurs. It may also present as minor discomfort with tampons, pelvic exams or intercourse.
Our patients have often been told that "there is nothing physically wrong" with them or that they "are too high stress and just need a glass of wine". We feel responses like this are unacceptable and dismissive of the real physical pain that these women have.
