An Intro to Pelvic Pain

Today we are diving into the topic of pelvic pain.  This is a broad umbrella category and many different types of pelvic pain conditions exist so please note that this is an overview.  If you have questions about a specific pelvic pain condition, you can contact me directly here. 

Pelvic pain can be considered any type of pain within the pelvis.  For a male pelvis, this includes the top of the pelvis, the perineum, penis, testicles, rectum and anal opening, and buttocks.  For the female pelvis, this includes the mons pubis (top of the pelvis), both labia majora and minora, clitoris, vagina, urethra, anal opening and rectum, perineum and buttocks.  To keep things simple, we are going to start with general pain conditions for both male and female pelvis. 

Vulvar and Vaginal Pain Conditions:

The vulva is categorized by the mons pubis, both labias, clitoris, urethral opening up to the vaginal opening.  Vulvodynia is a pain condition where there is pain; such as burning, stabbing, tingling, aching, dullness or any other sensation in this area.  Typically with vulvodynia, the pain is chronic (is has been there longer than three momths) and there is no identifiable cause.  This means there is no rash, infection or other known reason for the pain to exist.  

Vestibulodynia is a pain condition that is very similar to vulvodynia.  The only difference in name is because of its location.  The vestibule is the vaginal opening and inner labias above the vaginal opening.  Pain can be burning, sharp, dull, tingling, achy or just general discomfort.  Often people with this pain condition or with vulvodynia have difficulty with sensations such as wearing tight underwear, leggings or pants.  

Vaginismus is a pelvic pain condition that causes pain or diffuclty with penetrative intercourse or insertion of period products and pelvic exams.  Vaginismus is an involuntary contraction of the pelvic floor muscles on penetration that makes penetration very painful.  There are two types of vaginismus; primary vaginismus which occurs when vaginismus has always been present.  Often these patients are the have never been able to have a pap test or insert period products such as tampons and menstrual products.  Secondary vaginismus develops later in life, i.e. it hasn’t always been present.  The most common instances that I have seen of secondary vaginismus are following childbirth or following trauma of a sexual nature.  Often partners will describe feeling like they are hitting a wall on penetration and patient’s will report pain is there with penetration only, but when penetration stops the pain typically stops. 

Male Pelvic Pain:

Male pelvic pain conditions are often less commonly talked about, however I see many males in clinic with pelvic pain.  Here are a few pain conditions someone with a male pelvis may experience that can cause pain in the pelvis. 

Perineum pain:

Perineum pain is pain that is sharp, dull, burning, aching, stabbing or any other type of pain.  The perineum in males is the space between the scrotum and the anus. Sometimes this pain can refer into the rectum, but often it is just in the perineal area.  

Testicular pain:

Testicular pain is another common pain in males.  Sometimes this can be a referral from the pelvic floor muscles, sometimes it can be from varicoceles (swollen veins within the testicles) and sometimes it can be a chronic pain that is present for no known reason.  If you have a sudden onset of testicular pain, it is important to visit your doctor to rule out testicular torsion.  

Penile Pain:

Pain in the penis is another common pain condition in the male pelvis.  It can be referred from the pelvic floor, it can be caused by an infection or there may be pain present with no known cause.  This pain can be referred into the shaft or base of the penis or into the tip of the penis.  This pain may or may not be present when you go pee. 

Other pelvic conditions:

If none of these sound like you so far, keep reading! There are several pain conditions that may cause pain in the pelvis as a byproduct of the condition, and often these conditions require a diagnosis from a doctor.  However, seeing a pelvic health physiotherapist can help you manage some of this pain, even if your condition is chronic. 

Endometriosis:

Endometriosis is a condition in which tissue that is similar to the endometrial lining is found outside of the uterus.  Typically this tissue is found in the pelvis, however there can be a large variation in where the lesions present.  The location of the lesions can also cause symptom variation among people with endometriosis.  

There are four different stages of endometriosis, minimal, mild, moderate or severe.  These stages are categorized by the number of implants and the severity of the adhesions.  It is important to note however, that the stage of endometriosis does not always correlate to the symptom experience. 

PCOS:

Polycystic ovarian syndrome is another pelvic pain condition where cysts (small fluid filled sacs) grow on the ovaries and can cause pain.  Other symptoms of PCOS can include infertility, obesity, acne or weight gain, which can be related to hormonal imbalances associated with PCOS.  

Lichens Sclerosis:

Lichens sclerosis (LS) is an autoimmune condition that creates patchy, white skin in the vulvar area, genital or anal area.  The skin also becomes papery, thin and can cause tearing.  Lichens sclerosis can create pain in the area where it is present as well as itching or discomfort.  If you think you have LS, it is important to talk to your doctor and seek treatment.  Medical management including steroid creams is an important element of your treatment program along with seeing a pelvic PT. 

Woah, that was a long one, but I wanted to make sure we covered a variety of topics! There are many reasons that someone may be experiencing pelvic pain, and I only touched on a few pelvic pain conditions here.  If there is a specific condition you would like to see talked about, feel free to shoot me an email here.  Please also remember this material is intended for educational purposes only, this is not a substitute for a diagnosis.  If you have concerns, please speak to your primary care provider.  I hope you enjoyed this introduction to some different pelvic pain conditions.  Stay tuned for the next post; we will be talking about painful intercourse and some tips to manage it.