"doing mode", you're operating almost exclusively in the sympathetic branch of your autonomic nervous system. This system is associated with the "fight or flight" response, shallow breathing patterns, muscle tension, and increased heart rate and blood pressure. These stress responses of the body not only negatively influence the pelvic floor muscles but also the overall pelvic region including bladder and bowel function, both common triggers of genital, sexual, and pelvic pain. 2. Pelvic Traumas, Injuries, or SurgeriesInjuries to the pelvic floor region caused by childbirth, previous pelvic surgeries, falls on the coccyx bone, and other accidental traumas to the region such as straddle injuries can all contribute to the development of chronic pain in the pelvis and genital area. Take for instance, the condition once known as "bikers syndrome" that affects long distance bike riders. Cumulative targeted pressure on the pudenal nerve overtime can cause damage to the nerve. This particular nerve branches out into the entire vulvar region and can therefore emit painful stimuli anywhere in the pelvic region, not just at the "sits bones". 3. Present or Past Physical, Emotional, or Sexual AbuseMemories from past (or current) abuses are stored in pathways along the central nervous system, and even in particular muscles, especially the psoas muscle. The psoas muscle has a direct and neurological connection to the pelvic floor muscles. These bad memories that are stored by the nervous system awaken when it is feeling threatened or when trying to protect itself. Even when attempting consented, pleasurable sex, the nervous system can interpret this environment as threatening. Protective measures include muscles tension and clenching (which leads to pain, which leads to the fear of pain, which leads to further clenching), and the over-sensitization of the pelvic nerves. 4. Participation in Competitive SportsMany popular sporting activities require tight, clenched body positions and breathing from the chest in order to perform. If we are taught by these sports (or cultural influences) to suck in our stomach and breathe from the chest and clench our buttocks at all times as a matter of "good posture" this can, over time, be detrimental to the health and function of the pelvic floor. In addition, young women who participate in sports are more likely to experience sports-related injuries such as injuries to knees, ankles, legs, and hips. If a knee, for instance, is favored for a long enough period of time the opposite pelvic area takes on more stress and can contribute to pain due to compensatory patterns. 5. Genetic, Hormonal, & Dietary InfluencesStructurally the body is not symmetrical and consequently curvatures of the spine, leg length difference, being left or right footed, all have a bearing on the long-term cumulative stress on one side of the pelvis or the other. Genetic and hormonal influences can also put us at risk for other triggers commonly associated with pelvic, genital, and sexual pain. For instance, endometriosis, irritable bowel syndrome, and interstitial cystitis (painful bladder syndrome or "IC"). The dietary decisions we make also influence how and when these triggers manifest in the body. Foods can promote the inflammatory responses contributing directly to pain, but also inhibit the immune system from functioning properly.
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 Chronic pelvic pain advocate, educator, and artist Soula Mantalvanos, brings us a new creation that is an incredible gift to anyone suffering from chronic pain. A chronic pain patient herself, Soula created this remarkable tool for patients by a patient. {Pain}Train is a web-based platform that allows us patients to store everything related to our pain in one place. So instead of trying to explain to multiple health care providers for the umpteenth time about you, your pain, your treatments, and your history - give that health care provider access to your {Pain}Train profile and it's all there for them. Your online profile allows you to save all your information on medications, treatments, health care providers, and dates. It also allows you to upload documents, images, and reports. Beyond the medical only, it also allows for a more holistic picture of who you are by telling your professional and personal story pre-injury. And of course there is space to describe your injury, your symptoms, your diagnosis (if you have one), any other medical history or conditions, and you can store all your information on any health care coverage. There is also a mood tracker and plenty of space to include additional information for your unique situation. Access to all of this information is secure using HTTPS protocol and your email address with chosen password. The "access" feature allows you to share your profile with anyone you want to give permission to view it. Simply input each health care provider into your account and they will be assigned a unique code (or QR code) for 'read only' access to all of your profile. You can either email this information to them or print it for them. Example Profile So Organized! FREE 3 Month "Test Ride"Since {Pain}Train is offering a free "test ride" for 3 months, I tried it out for myself. I must admit, it was pretty daunting to sit down and fill in everything (and I'm not even close to being done!) But I told myself to take it in chunks. Do a little now and I can always come back to it later, everything is saved and I won't lose what I've started. And once it's done it'll be a tool I can use and reuse and update, making life so much easier. I'm planning on taking it with me to my Ob/Gyn appointment this month. And since I'm not sure if she'll be interested in having email access to my profile, I'm planning on printing it. Thankfully, the print function creates a printer-friendly, well laid-out, physical page copy version of the profile. See below: Printable VersioN Print Version Looks Nice Too! SubScription to {PAIN}TrainIf after 3 months you are finding the platform helpful, it's just $29AUD yearly to continue your subscription. That's currently about $20/year US, based on the current exchange rate. If you choose not to subscribe after your 3 free months, your profile will be deleted. {Pain}Train doesn't ask you for payment information when you first register an account. After 3 months {Pain}Train will prompt you to pay the annual subscription fee. Pay at that time to keep your subscription. Your profile is deleted if you decide not to subscribe. I encourage you to give it a try! All Aboard! Need some help creating your profile? Download simple profile instructions from {Pain}Train.
Entrance Pain: Vestibulitis (Vulvar Vestibulodynia) Vaginal penetration pain, or vaginal entrance pain. Pain in this region when "provoked" (trying to insert any object into the vagina) is most commonly due to a condition popularly known as vestibulitis. Vestibulitis is thought to be caused by highly sensitized nerve endings being contributed to by other pelvic pain triggers. This condition is frequently misdiagnosed as vaginal infections.
But let's back up. What do we call the vaginal opening anyway? If I had known more terms in my own research for answers, I may have gotten a bit farther a bit sooner. Vocab Lesson 1: What is the vaginal opening? The vaginal opening is known as the vestibule. The vestibule contains large amounts of pain receptors. Vocab Lesson 2: So then where is the vagina? The vagina is actually muscular tubing inside the female reproductive system that runs from the external genitalia to the cervix. Vocab Lesson 3: If that's the vagina then what do we call the external genitalia? The entirety of the female external genitalia (including the vestibule) is called the vulva. Vocab Lesson 4: So if I have pain at the vaginal opening... ahem.. I mean the vestibule... then what is that called? Pain in the vestibule is called Vulvar Vestibulodynia or Vulvar Vestibulitis (or you might hear it called just vestibulitis). Vocab Lesson 5: What if my pain occurs in other areas "down there" or seems to be spontaneous instead of provoked? Chronic pain anywhere in the region of the vulva (as far back as the rectal opening and as far forward as the clitoris) is known as vulvodynia. Vulvodynia has two categories. 1: Vulvar Vestibulodynia (see Lesson 4) and 2: Generalized Vulvodynia Generalized Vulvodynia is unprovoked pain. It is relatively constant and often described as burning or sore. It can occur in just one specific area or in multiple areas around the vulva. It is less common and more difficult to successfully treat. Pain emanating from the pudenal nerve may be a significant contributor to this condition in some cases (pudendal neuralgia). So that's the vocab lesson for now in vaginal penetration pain, or vaginal entrance pain. Want to understand more pelvic and genital pain related vocab? Go to the Glossary.  New to paindownthere.com this month: we've added digital chapter packages in our products page. There are five chapter packages, each include a unique set of specific chapters from the Video Series Healing the Pain 'Down There': A Guide for Females with Persistent Genital & Sexual Pain.
Each digital package is designed to address five main topics: 1. Explaining Pain: The science of pain and as it relates to chronic pain 'down there'. Everyone should know this information. Our team doctor uses these chapters to prep his patients before an appointment because everything he's going to tell them about pain science as it relates to Chronic Pelvic Pain disorders is in here. 2. Brain Neurobiology & Healing: Don't let the title scare you! Easily learn the basics of brain systems and strategies for healing the brain, including mindfulness-based stress reduction. 3. Physical Therapy (Breath, Posture, Stretching): Practicing appropriate breath, posture, and stretching techniques for pelvic floor and core functionality and health. 4. Physical Therapy (Relaxation and Strengthening): Practicing relaxation and strengthening techniques for the pelvic floor and hip musculature. 5. Physical Therapy (Dilator Use): Specific guidance and instruction in the use of dilators to desensitize pain responses in the pelvis for decreasing pain with sexual intercourse. Each digital package is priced individually so that if you're only interested in one or two packages you only pay for what you want, making our guide more accessible and affordable.  Laura Ricci is a licensed doctor of physical therapy specializing in Women's Health and Pelvic Floor Rehabilitation, as well as a certified Women's Health Nutrition Coach (WHNC) through the Integrative Women's Health Institute (IWHI).
Join Laura online as she discusses her personal experience with post-surgical pain and recovery on Friday September 18th as part of The Healing Pain Summit. Registration is free! Laura will talk about her Physical Therapist's Guide for Healing from Surgery and include tips for optimizing surgical healing. The free online summit launches September 14th so take advantage of other great presenters and topics and register for free now.  The long-awaited Video Guide Healing the Pain 'Down There': A Guide for Females with Persistent Genital & Sexual Pain is now available for purchase. Learn More: A woman with chronic pelvic pain brought together a team of multidisciplinary professionals to create this instructional and educational DVD guide for those suffering with “pain down there”. The team represents over 50 years of experience in women’s health related fields including OB/GYN, physical therapy, mindfulness techniques, and human sexuality with their focus being on the treatment of pelvic pain. This educational video is intended for women of all ages who are experiencing pain during intercourse who want to learn why they have their symptoms and learn strategies to improve them. This video is also for teens and young women who may be at risk for developing these symptoms, and for clinicians who are practicing in the field of women’s health. “Groundbreaking … “ Jill Osborne, MA ICN Founder & CEO “A well designed comprehensive view of pelvic pain from a multidisciplinary perspective and clear options for returning to health and well being.” Sandra Hilton, PT, DPT, MS “A very important resource for many women...” Frank Tu, M.D., MPH " Respected pelvic practitioners create a road map to navigate the challenging path of healing pelvic pain." Dustienne Miller PT, MS, WCS An important way to promote or restore function and control of the pelvic floor is through the breath. Clenched abdomen and habitual breathing from the chest directly affects the pelvic floor, making it too tight/tense and "turned on" which can contribute to sexual pain. Shallow chest breathing also cues our bodies into the tensing, fight or flight mode of the nervous system (see previous blog).
Breathing is meant to come from the abdomen/diaphragm, not from the chest. If you've been taught by sports or cultural influences to suck in your abs and breathe from your chest you may need to re-train your body to breathe appropriately. Musculoskeletally, the respiratory diaphragm and the pelvic floor work together. As you inhale .... the diaphragm lowers and the pelvic floor expands. As you exhale... the diaphragm and pelvic floor return to their elevated positions. Therefore, if you are constantly breathing from your chest, your pelvic floor never gets a chance to relax and expand. Mentally check into your breath pattern throughout the day to ensure proper breathing techniques. We go more in depth about how to do this in the DVD, Healing the Pain 'Down There': A Guide for Females with Persistent Genital and Sexual Pain.  Remember, mindfulness is the practice of being in the present moment without judgment or the intention to change anything. This practice is actually a way of living, a way of being. We often go about our lives without living in the present moment. Either we are thinking about the past or worrying about the future.
Through the practice of being present in the moment comes a quieting of the mind and calming of the body. And it offers us space to choose what our mind focuses on. When we have this choice, we can choose to focus on the things that feel better. When we stay in the "doing" mode for too long and live life on "automatic pilot" two things can occur: 1. Negative emotions and reactions can be triggered 2. It can jumpstart habitual coping patterns, such as mindless eating or biting our nails In the context of pain, we recognize signals being sent up to our brain from a certain part of the body and then our minds (depending on our neuromatrix) add meaning and assumption in interpreting these signals. If we don't know about our bodies and what is going on, the danger flags rise and our pain 'volume dial' gets turned way up. I hope I've convinced you to at least consider Mindfulness-Based Stress Reduction. If you're ready to give it a try, please first read the blog about the Mind's Error Detection System. And keep in mind that when you're first practicing mindfulness, it's normal for the mind to distract you, making you wonder if you're doing it right and telling you how hard it is to "not thinking about anything". It'll feel like a dance between the "doing" and the "being" mode. This is ok. Expect it. And it will get better. The more you practice, the more your mind will be quite and peaceful during this time. There are two different approaches to mindfulness you may find helpful: - An active way: "Google" search for Mindful Eating Script and have a partner read it out loud while you enjoy mindful eating - A Meditative way: Using sensory awareness and using the breath as the main anchor to the present moment. Guided Meditation has been my method of choice because the "work" is done for you as you listen to the audio voice that is leading you into a peaceful place. Here's a 3-Minute Breathing Space MP3 that only costs .99, give it a try. And notice how your body feels after only three minutes of focusing on the breath. Purchase the whole album from our content provider, Alexandra Milspaw, PhD, LPG if you find this method works well for you!  So to recap:
The amount of danger signals that are sent up to the brain + The level of threat that is perceived by the brain = The amount of pain we experience In the context of chronic pelvic pain, the brain either perceives safety or danger. The more it perceives danger, the more pain we experience. It is important to note that chronic pain is not prolonged acute pain. "Chronic Pain" is the result of our brain interpreting signals through our nervous system, commonly long after the actual tissue damage has healed. Triggers of these signals in the pelvic region can include one or more of the following: 1. Functional Systems (bladder, bowel, uterus, prostate in male pelvic pain) 2. Structural Systems (muscles and ligaments, often in spasm) 3. Nerves firing (causing tingling, burning, itching, dryness, aching, or even stabbing of surface tissues) All of the signals from these triggers add up in our memories, emotions, and thoughts. These signals are also called "generators". When generators are sent up to the brain, the brain responds by sending down corresponding inhibitors. For example, when we stub our toe it really hurts for a couple of seconds! Until our inhibitors take over. Our brain immediately tells us that by all of our previous experiences, stubbing our toe is not dangerous. So the pain quickly fades away. But with chronic pain, the generators outweigh the inhibitors and the volume of our nervous system gets "turned up". Over time, the nervous system responds more and more strongly to a smaller amount of signals. This is one reason why sensitivity related to the external genitals and pelvic floor, for example, can increase over time when not treated and managed properly. The more we understand what is going on in the body, how pain is processed, and the more "tools" we have to temper these signals and how they are reacted to in the brain, the more we are likely to reduce the pain or "turn the volume dial down". Focused training can help us guide us in the process. These tools include: Mindfulness-Based Stress Reduction, diaphragmatic breathing techniques, and physical therapy. As well as other disciplines like medicine, psychological counseling, nutrition and dietary changes, yoga, and massage. |
AuthorStephanie Yeager: Passionate about spreading the word of hope and healing for those like her, influencing a paradigm shift in the medical community toward greater understanding of chronic pelvic pain disorders, and prevention initiatives that may protect young women before onset can occur. Archives
July 2018
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