Alphabetical Index of Articles on Women's Sexual, Pelvic Floor, and Reproductive Health

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)

Does Fear Create Vaginismus? Or Vice Versa?

I came across an article that came out last month and it brought up an old question I often muse over--Does Vaginismus create the fear and anxiety in women, or does an underlying fear or anxiety create Vaginismus? As we often say in physical therapy "It depends".

With some of my patients, there is a specific injury or infection that is at the root of their pain. The story is similar whether they were diagnosed with Vaginismus, Vulvodynia, Vestibulitis, Dyspareunia, or a host of many other diagnoses that lead to painful intercourse. For example, a young girl that always wore bathing suits and developed recurrent yeast infections, only to find out that over a decade later she had developed vaginismus. She had no fear or anxiety going in to first sexual encounter, yet she had severe pain. Now, she presents with what I perceive as fear and anxiety. Should she be treated for fear and anxiety? Or just the pain? Or both?

Heather Jeffcoat was once again the featured guest on the hugely popular podcast Girl Boner Radio with August McLaughlin! In this episode they discuss the pelvic floor, painful sex, and physical therapy after gender affirming surgery.

We Take a Look at Combined Methods of Hormonal Birth Control and Vulvodynia

In this three part series, we will explore the effects of hormonal contraceptive methods and their relationship with vulvodynia.

What is Hormonal Birth Control?

Hormonal birth control methods, such as birth control pills, patches, injections, rings and hormonal intrauterine devices (IUDs), work by altering hormone levels in the body to prevent pregnancy. Hormonal contraceptives fall into two categories: combined, meaning they contain both estrogen and progestin (think the pill, patch, or ring), or contain progestin only (think progestin only pill or “POP”, arm implant, IUDs, or injections). While the primary intent of these drugs are for contraception, they are also widely prescribed for other common issues such as: mood imbalance related to periods, skin issues, irregular periods, and painful periods. 

Hormonal Birth Control and Vulvodynia - Part 2: Hormonal Intrauterine Devices (IUD)

This article takes a looks at intrauterine devices (IUDs) and it’s potential effect on vulvodynia, or vulvar pain.

Intrauterine devices, also called long-acting reversible contraceptives (LARC), have become more and more popular as a birth control method in the United States due to high efficacy, less side effects and higher continuation compared to other hormonal contraceptive methods^1,2,6. They are offered in two forms; hormonal (common brand names are Mirena, Kyleena, Skyla, Liletta) and copper IUDs. For this blog, we will be exploring the effects of the hormonal IUD only. This type of IUD releases progestin into the body which suppresses endometrial cell growth (called proliferation) and thickens the cervical mucus to prevent pregnancy⁴. 

I consider myself to be a case study when it comes to the topic of hormonal birth control and pelvic pain. I have tried several variations of the combo pill, progestin only pill, the Mirena IUD and most recently, the Nuvaring. When taking the combination methods, I definitely noticed the side effects previously mentioned in my last blog post. However, in my early twenties, when I was on the Mirena (hormonal IUD), I didn’t notice any of these side effects.

The Relationship Between Hormonal Birth Control and Vulvodynia

Is the hormonal birth control mini pill better than the regular pill?

If you have been following along, this is the third part of our hormonal birth control and vulvodynia series. First, we covered how combination methods of birth control (containing synthetic forms of both estrogen and progesterone) could lead to vulvodynia. We then explored if there is a risk of developing vulvodynia after the insertion of a hormonal intrauterine device IUD). In this post, we will delve into the relationship between the progesterone only birth control pill, also called “the mini pill,” and vulvodynia. As a quick refresher, vulvodynia is pain on the vulva, or external genital tissue. For more information about vulvodynia, check out this post on our website.

Similar to the hormonal IUD, the mini pill works as a contraceptive by thickening cervical mucus and thinning the lining of the uterus to prevent a fertilized egg from implanting. Similar to the IUD, it is an expected side effect to experience spotting in the first few months of use1. Interestingly, some women will no longer ovulate, while some will continue to, about 4 in 10, according to the American College of Obstetricians and Gynecologists¹. 

I’ve said it before and I’ll say it again – pelvic pain isn’t in your head, it’s in your muscles.

But could it also be in your birth control?

That’s one of many questions a team of scientists from the European Society of Sexual Medicine set out to answer recently by taking a comprehensive look at the current body of research on how hormonal contraception can affect female sexuality.

Sadly, the first takeaway is no surprise. We need more research – a lot more. And of all the different facets of female sexuality they examined, pelvic floor and urological symptoms got the least attention from the scientific community.

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

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.

Should You Stop Doing Kegels?

Read on for the answer.

In my last post, “Why You Should Be Doing Kegels NOW”, I went over the specific diagnoses that tend to benefit most from doing pelvic floor muscle exercises. However, not all issues related to the pelvic floor are appropriate to prescribe pelvic floor muscle exercises for. In fact, doing Kegels can actually be harmful and counterproductive to your symptoms if you have certain diagnoses, and it may be best if you stop doing kegels depending on your diagnosis.