Vulvodynia Vulvodynia is chronic pain of the area around the vagina, known as the vulva. It may be generalized or specific to only one area. Symptoms my include feelings of burning, stinging, icing, aching, throbbing or swelling. It may or may not be accompanied by spasm (vaginismus). Treatment depends on the source of the pain, which is typically multi-factorial.
Vaginismus Spasm and tightness of the pelvic floor muscles that limits penetration is known as vaginismus. It may make penetration extremely painful or even impossible, including sexual activity, tampon use, and gynecologic exams.
Coccydynia The coccyx, or tailbone, is a bone located at the base of the spine near the anus. It is attached to the sacrum by ligaments and should be able to move about 25 degrees forward and backwards to accommodate normal activities for example sitting, bowel movements, and childbirth. In cases of physical trauma such as falls, car accidents, or difficult childbirth the coccyx or its surrounding soft tissue may be injured. In some cases injuries may be very old, such as a childhood fall, but trauma to the tailbone remains and over time the lack of mobility culminates in pain and dysfunction.
Tailbone pain may be experienced as an inability to sit for long periods of time, pain with intercourse, or pain with bowel movements. It may also radiate up into the pelvis, sacrum, or lower back. Using manual physical therapy to mobilize the tailbone, align the pelvis and sacrum, improve tissue mobility, and improve muscle function, tailbone pain can be decreased or eliminated.
Proctalgia Fugax This sudden, severe rectal pain usually lasts only a few seconds, but may last minutes. It is often reported to happen at night, although it may occur at any time during the day. It is a shocking pain that often makes sufferers gasp, and comes on sporadically without warning. Physical therapy for proctalgia fugax involves calming the spasming muscles and re-educating them to prevent future spasm.
Levator Ani Syndrome The levator ani are a group of strong, supportive muscles in the pelvic floor. When they become too tense, or even go into spasm, they can cause pain in the vaginal and rectal area. This pain is often in the area of the rectum, but may also affect the area of the vulva. It may feel like "fullness" in the rectum, pain with sitting, pain or relief with bowel movements, or even odd sensations such as "flickering" or "vibrating." Pain may be worsened with sexual activity, and it may also include urinary symptoms, constipation, or burning sensation. Physical therapy addresses levator ani syndrome very successfully by directly and/or indirectly treating the spasming muscles.
Pain with Intercourse
As many as 60% of women will experience pain with intercourse at some point in their lives.[i] Of these women, few actually seek treatment, believing that the topic is taboo, that they will not be believed, that nothing can be done for them, or that the pain is normal. In fact, we frequently find women in clinic who went their whole sexual history having pain with intercourse, and believing that it was normal sensation.
Some women experience pain at the entrance of the vagina, while others may experience pain with deeper penetration. Pain may be experienced just before, during, or after sexual activity.
Chronic Non-Bacterial Prostatitis, or more accurately, Chronic Pelvic Pain Syndrome
This pelvic pain syndrome used to be called "chronic non-bacterial prostatitis" because the pain was in the area of the prostate/anus/pelvic floor, was not associated with a bacterial infection, and was chronic without known cause. However, this pain has nothing to do with the prostate directly. Instead, when treatable with physical therapy, it involves the muscles and nerves of the pelvic floor muscles. Symptoms vary but may include pain or altered sensation in the sit bones, rectum, perineum, scrotum, or penis. Symptom may also include urinary frequency/urgency/incontinence, sexual dysfunction, and constipation or fecal smearing. Fortunately this frustrating and life-disrupting pain can be treated successfully with physical therapy, with or without other medical interventions.