Category: Genital Pain

How To Naturally Quiet Penetration/Entrance Pain

9/5/2018

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How To Naturally Quiet the #1 Cause of Penetration/Entrance Pain (In Reproductive Aged Women)

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SELF CARE TIPS FOR WOMEN WITH SEXUAL PAIN

1/24/2017

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Take a look at these personal care tips from Dr. Echenberg. Triggers that increase your pain sensitivity could be hiding in your self-care routine.

1. CHANGE YOUR PAD OFTEN

Because the pH balance of the vagina changes during your period, you can be more susceptible to vaginal infections during this time. In addition, damp pads and blood can cause irritation and also open the door for infection. As a preventative, change your pad every two hours. Be careful of tampon use as they soak in far more irritating fluids than pads and the insertion of tampons alone can cause pain to the already inflamed and sensitive genital tissues. Be sure to use menstrual products that are free of perfumes and any harsh ingredients. We recommend: Natracare

2. USE UNSCENTED LAUNDRY PRODUCTS

Perfumed laundry soap, fabric softener, and scented dryer sheets can inflame the genital area. Look for versions of your favorite products that are unscented and free and clear of dyes. Many store brands even have a free and clear version of these products. It also might be worth considering alternatives like wool dryer balls and DIY recipes so you know exactly what's inside.

3. WASH YOUR VAGINAL AREA WITH WATER ONLY

That's right! It might sound strange but the external genitalia doesn't need any more than water. Soap can upset the sensitive balance of the vaginal flora and increase symptoms. If you feel like water just isn't enough you can try unscented soaps. But be aware that it's possible to have a sensitivity to glycerin (the main ingredient in many unscented soaps) so take note of any irritation. There are glycerin-free alternatives but pay close attention to their other ingredients.

4. BEND OVER TO RINSE OUT SHAMPOO

When you rinse your hair in the shower be sure to bend over in a way that shampoo can't run down over your vulvar area. Chemical ingredients, perfumes, and dyes can cause an adverse reaction when coming in contact with your genitals.

5. WIPE THE RECTAL AREA PROPERLY

Vaginal infections can be caused by bacteria from the rectum. Always wipe from front to back and change your underwear when possible after a bowel movement as bacteria can remain on the underwear.

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WHY DO I HAVE VAGINAL PAIN? A SCIENTIFIC LOOK AT THE VULVAR VESTIBULE

11/30/2016

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If you were to take a mirror and take a look at the opening of your external genitalia, you would be looking at your vulvar vestibule. The vulvar vestibule (or “entrance way” to the vagina) includes from the clitoris to the urethral opening (for urinating) to the vaginal opening as well as portions of the inner lips on either side of the vaginal opening. Many incorrectly refer to the whole area as “the vagina”. Actually the skin of the vestibule lies between the vaginal lining and the outside hair bearing skin. If you need a little help on vocab and anatomy - check out this blog.

It is also really important to realize that the most common reason for entrance pain with intercourse, tampon use, vaginal speculum or just light touch from clothing is the common condition known as vulvar vestibulitis or better called vulvar vestibulodynia. (“itis” means inflammation and “dynia” means pain).

So back to looking in the mirror. You’ve probably never whispered “you’re special” to your vulvar vestibule. But it is. Not just for its role in the reproduction of life, but because the external tissues in that area are actually very different from other mucosal surfaces in the body. Mucosal surfaces are those bodily tissues that excrete mucus like the inside of your mouth and the inside of your nose. The difference is in the “profile” of the immune cells in that area, meaning the type and the amount of the cells of the immune system. Given how important the external genitalia is to the reproduction of life, we would suspect that it would indeed be a place that needs some extra immune system defense. This same observation holds true for other species as well, not just humans.

We also know that one of the methods the immune system uses to attack what it identifies as a threat to the system is inflammation. And as a result of inflammation we often feel pain. It makes sense then that pain brought on by inflammation at the vulvar vestibule would be different than the pain brought on by inflammation at other mucosal sites. Recent research seems to indicate that pain felt in this area is determined by 1) the amount (not simply the presence alone) of low grade inflammation, 2) altered vulvar nerve innervations, meaning an abnormality in the distribution of impulses of the nerves in that area, and 3) genetic susceptibilities that contribute to abnormal inflammatory cascades (chemical messengers that ramp up the immune system and cause a domino effect).

Vagina! (You are definitely more complicated than we thought!!!)

Just making sure you’re still with me here, this information is dense but it’s how we know persistent genital, sexual, and pelvic pain has a MEDICAL and SCIENTIFIC explanation.

Ok, back to the mirror. We know that the vulvar vestibule is derived (or made from) the endoderm. When we were just embryos in the womb, the inner-most layer of that embryo is called the endoderm. Do you know what else was derived from the endoderm? The bladder and urethra and also the gastrointestinal tract. It is possible that these other structures also have unique immune profiles, similar to that of the vulvar vestibule.

Let’s briefly recap: The vulvar vestibule has a unique immune profile compared with that of other mucosal sites. An immune/inflammation response at the vulvar vestibule isn’t enough to cause pain. Pain is determined by the magnitude of the immune response/inflammation. The vulvar vestibule, the bladder, and urethral linings are all derived from the endoderm and could share immune profiles.

One last piece of information that’s critical to note: the most recent research is finding that in the clinical setting, self-reported pain levels at the vulvar vestibule are closely connected with the release of an immune system messenger known as cytokine. That means when research study participants reported increased pain, the presence of cytokines in the examined vulvar tissue also increased.

What does all of this really mean? It means that we know that chronic genital, sexual, and pelvic pain is real in a clinical and biological sense. We of course recommend treatment modalities that work from the top-down to address the mind-body connection and help turn the central nervous system pain ‘volume dial’ down. But we also want to highlight the science behind the pain and the need for bottom-up approaches in line with current research and the desperate need for earlier diagnosis and appropriate treatment modalities and medications to counter these inflammatory and painful processes.

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10 CONDITIONS COMMONLY ASSOCIATED WITH SEXUAL PAIN

10/26/2016

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10 Conditions Commonly Associated with Sexual Pain

1. Fibromyalgia, Migraine, and other Chronic Pain Conditions

The conditions can cause body/joint aches, tender points on the body (trigger points), exhaustion, fuzzy thinking, and sleep problems. Hypersensitivity of the central nervous system may be the linkage between these various disorders and chronic pelvic and sexual pain. All can be considered as chronic regional pain syndromes.

2. Interstitial Cystitis (IC)

Unlike the kind of cystitis that can be treated with antibiotics, IC is a chronic inflammatory condition of the bladder wall. Some of the symptoms are an urge to urinate frequently, stinging the area surrounding the urethra, increased nighttime voiding (urinating), and a variety of pelvic and sexual pain symptoms.

3. Irritable Bowel (IBS)

Constipation and/or diarrhea are symptoms of this syndrome. Some women find that IBS flare ups correlate to an increase in vaginal irritation. Therefore foods that aggravate the bowel may also cause vaginal symptoms.

4. Lichen Sclerosis

This is an inflammatory chronic skin condition most common in the external genital area. Symptoms may range from none (for years) to mild or severe itching and irritation. Lichen Sclerosis does appear to be relatively prevalent in women with vulvodynia and sexual pain disorders. It can cause splitting and "paper cut" type tears in the region around the vaginal opening.

5. Myofascial Pain Syndrome

Myofascia are the muscles and connective tissue in the body. When in spasm, knots and "trigger points" develop that need to be released to eliminate pain and restore function. These trigger points in the pelvic myofascia can cause sexual pain.

6. Pelvic Endometriosis

Endometriosis occurs when endometrial cells, normally found only in the uterus, become imbedded in locations outside the uterus. These locations are usually within the pelvic cavity on reproductive organs, supportive ligaments, or structural systems like the bladder or bowel.

This misplaced tissue forms growths that look like dark spots. These growths respond to the menstrual cycle and break down and bleed each month, the same way the lining of the uterus does. This causes cyclical pain and inflammation - called dysmenorrhea. Additionally, the body’s immune response to this internal bleeding and breakdown of blood and tissues begins to cause scar tissue and adhesions (affected pelvic organs or structures adhering to one another) which can also cause ongoing pain.

Endometriosis affects millions of women but is often over diagnosed as the primary cause of pelvic and sexual pain. If the pain or deep sexual discomfort is intermittent and all month long, even though it may become worse leading up to the menstrual period, endometriosis may not be the primary reason for the pain. If you have been diagnosed and treated for endometriosis and you don't begin to get signifiant improvement either after medication or surgical treatment, insist on further evaluation for bladder, bowel, musculoskeletal, or nerve related causes of your pain.

7. Pelvic Floor Dysfunction

The pelvic floor encompasses all the muscles that surround and support the pelvic organs (uterus, bladder, and lower bowel). To function appropriately, these muscles must be toned. However, elevated tone in the pelvic floor muscles, making them too tight, tense, and "turned on" can result in painful sex and difficulty with bladder and bowel function. On the other hand, too little tone can lead to bladder and bowel incontinence (leakage) or prolapse (falling down, out of normal position). Pelvic floor dysfunction can refer to either too much or too little tone.

8. Previous life-long Pelvic Trauma

Events such as physical, emotional, and sexual abuse, surgeries, accidental injuries, and cumulative aggravating structural factors can play a role in sexual pain. Additional possibilities include years of various sports activities such as gymnastics, cheerleading, track & field, soccer, ballet dancing, horseback riding, skating, etc. More and more women have engaged heavily and competitively in these sports over the past few decades, making them extremely vulnerable to these types of bodily stresses. The nervous system bio-chemically "imprints" and "remembers" these accumulated traumas, and any or all of these may predispose a young woman to sexual and pelvic pain disorders even years later.

9. Generalized Vulvodynia

Generalized vulvodynia is a subset of vulvodynia, it is less common than vulvar vestibulodynia (see below) and often very difficult to successfully treat. It is a deeper, more generalized pain. Pain can occur spontaneously (unprovoked) or in response to touch or pressure (provoked, such as by intercourse). Pain emanating from the pudendal nerve and its distribution may be a significant contributor to this condition in some cases (pudendal neuralgia).

10. Vulvar Vestibulodynia (Vestibulitis)

This condition causes pain and inflammation at the vaginal opening. Women describe the pain as burning, itching, raw, sandpaper, ground glass, and stinging. It is commonly mistaken for vaginal yeast infections and is often treated incorrectly. Vestibulitis is the most common reason for entrance pain (painful sex) in reproductive-aged women.

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Provoked Vulvodynia

9/30/2016

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Provoked Vulvodynia
An Update from The Journal for Nurse Practitioners
Volume 12, Issue 8, September 2016
Page 530

Overview:
This article by the Journal for Nurse Practitioners focused on the holistic treatment approach to provoked vulvodynia, highlighting several recent research findings that we’d like to share. According to the International Society for the Study of Vulvovaginal Disease, provoked vulvodynia is pain localized to the vaginal vestibule when provoked (touched) that has been present for at least 3 months and does not have a clear identifiable cause. Provoked vulvodynia (PVD) you may have heard also referred to as vestibulitis or vestibulodynia.

Origin:
How PVD begins isn’t known, but likely it is a complex combination of factors involving genetics, musculoskeletal and neurologic mechanisms, and psychological factors, including the interplay between chronic stress and pain, leading to a sustained pain response. Research has also shown that low confidence about how to manage and cope with the pain is related to higher pain intensity. Depression and anxiety further complicate PVD. As we are already aware, providers are generally unfamiliar with this disorder. Women see up to 6 providers before being accurately diagnosed and treated.

Treatment:
Current recommendations call for the least invasive treatment options available. This article focused on two treatment options which are noninvasive and comprehensive, yet often only recommended as alternative options: Cognitive Behavioral Therapy (CBT) and Mindfulness. CBT is a multi-session practice that includes relaxation, self-management techniques, and restructuring thoughts and emotions that are maladaptive. While CBT is a change-oriented strategy, mindfulness seeks to create awareness of the body, thoughts, and emotions by simply noticing them rather than judging them.

In one study, CBT was found to be superior to surgical procedures in pain relief with intercourse at a 2 ½ year follow up. And CBT has been shown to be more effective in reducing pain and improving sexual function than topical steroids. CBT was also found to improve patient confidence in being able to manage and cope with the pain, along with significantly reducing depression and pain anxiety. At the 1 year follow up these findings had either been maintained or improved.

Current studies also suggest that women with PVD benefit from the practice of mindfulness. Women were found to have significant improvements in their own confidence to manage and cope with their pain, along with decreases in pain hypersensitivity and feelings of hopelessness. Women who participated in a mindfulness-based CBT program experienced decreased depression, anxiety, and fear. These findings were maintained at the 6 month follow up.

Conclusion:
CBT and mindfulness are noninvasive, effective long term, and provide an approach that factors in both mind and body, not just physical pain. Current research would suggest these options be recommended as a first-line treatment instead of an alternative therapy. More evidence-based guidelines are needed for PVD in tandem with increased provider awareness.

In addition, we at paindownthere.com would add that further research is needed in the multidisciplinary approach to treating PVD. We believe highly in “top-down” approaches such as mindfulness but also recognize the need for simultaneous “bottom-up” approaches that take into consideration biological/medical factors that may call for medication, physical therapy, and nutrition intervention as well.

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NUTRITIONAL THERAPY FOR PELVIC PAIN

7/20/2016

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NUTRITIONAL THERAPY FOR PELVIC PAIN GUEST POST BY CERTIFIED WOMEN'S HEALTH AND NUTRITION COACH, SUSAN TESSMAN

Women's Health and Nutrition Coach Susan Tessman on the connection between food and pelvic pain.

“After years of working with thousands of women patients, I have found that no therapy can be fully effective without including beneficial dietary changes as part of the treatment plan." (1) Over 20 years ago those words in a book on endometriosis were my first introduction to the connection between food and pelvic pain. I had been diagnosed with uterine fibroids, ovarian cysts and advanced endometriosis earlier that year and was determined to try anything I could that might help to reduce the pain, and avoid having to undergo further surgery or deal with the emotional and physical side effects of hormonal treatments.

At that time there was much less access to information on complementary therapies for pelvic pain, but I learned as much as I could about a holistic approach for treating endometriosis and other pelvic pain issues that I developed. I followed specific dietary recommendations along with addressing other lifestyle factors like exercise, sleep, and mind-body practices and had regular treatment with pelvic floor physical therapy, acupuncture and massage therapy. It took trial and error to learn what worked best for my body, but I had great results in managing my health outcome.

Most of the time there’s not a magic bullet cure for pelvic pain - it takes an integrated and multi-disciplinary approach to support sustained healing. Whether you suffer with painful bladder syndrome, pelvic floor dysfunction, endometriosis, irritable bowel syndrome (IBS), vulvodynia, or other sources of chronic pelvic pain, nutrition can be used as an additional therapeutic tool to improve these conditions, and to heal co-existing health issues that can increase pelvic pain.

NUTRITION AND ROOT CAUSES OF PELVIC PAIN
When working with nutritional therapy for pelvic pain we want to consider what some of the root causes and triggers might be. It’s estimated that the breakdown of sources of chronic pelvic pain are approximately 37% gastro-intestinal, 31% from urologic causes, 20% reproductive system, and 12% musculoskeletal.

Studies have shown that chronic pelvic pain is frequently associated with systemic inflammation, including autoimmune diseases. (2)

A 2002 study reported in the Sept. 27th issue of Human Reproduction (3) concluded that hypothyroidism, fibromyalgia, chronic fatigue syndrome, autoimmune diseases, allergies and asthma are all significantly more common in women with endometriosis than in women in the general USA population.

Vulvodynia is associated with other chronic comorbid pain conditions such as fibromyalgia, interstitial cystitis and irritable bowel syndrome, individually and in combination, and the presence of vulvodynia or any of the other comorbid pain conditions increases the likelihood that a woman will have one or more of the other chronic pain conditions. (4)

If you suffer with multiple health issues, nutritional therapy can not only address the pain symptoms, but can also support healing in other inter-related body systems that can be impacting your pelvic pain. The right nutritional shifts can correct digestive disorders, improve the healthy balance of gut microbiota and ability to absorb healing nutrients, bring hormones and blood sugar levels into better balance – all of which can impact pain levels, support your recovery from surgery and medical procedures, and help to down-regulate the nervous system so pain response is not as intense.

ELIMINATION DIETS TO DECREASE INFLAMMATION AND PAIN
To begin to address pelvic pain symptoms, a personalized elimination diet is an important tool. What exactly is an elimination diet and why do we use it?

Most people are familiar with food allergies and how potentially deadly they can be. A food allergy reaction occurs when your body recognizes a certain food as harmful and produces an immune response to that food, which can result in severe symptoms. Antibodies produced in the allergic response (most commonly IgE antibodies) will show up on a food allergy test. 8 food groups have been identified as causing 90% of all IgE food allergies in the U.S.: Milk, eggs, fish, shellfish, wheat, soy, peanuts, and tree nuts.
But many of these same foods also cause reactions that may not produce IgE antibodies, but do cause other immune responses, and these reactions are referred to as food sensitivities or intolerances. A common example of this would be having “lactose intolerance” where you’re lacking the enzyme needed to properly digest this milk sugar. These kind of responses are often delayed and not always as obvious to detect. Symptoms of food intolerances can include digestive problems like bloating, cramping, constipation, diarrhea; headaches; sinus problems; unexplained weight gain; fatigue; skin conditions; and increased pain anywhere in your body.

You can imagine if you’re eating poorly tolerated foods over and over again, and each time your body is having a reaction, that this can lead over time to a chronic state of low-grade inflammation, as the immune system is always being activated. And once inflammation is ongoing, it can also lead to developing even more food intolerances, so a very negative cycle of inflammation is set up, and symptoms increase.

Testing for allergies and food intolerances can be extremely helpful, but tests are not always completely accurate, and can be expensive, so using an elimination diet can be another effective method to help identify these possible food sensitivities. One of the main goals of using an elimination diet with pelvic pain conditions is to calm down and reduce the inflammation cycle and resulting pain and symptoms, and allow the body to rest and heal.

ELIMINATION DIET BASICS
The nutritional advice I followed over 20 years ago for my pain was to stop eating dairy, wheat and sugar (and processed foods in general) and focus on whole foods. I’ll admit it wasn’t a total breeze at first! Those three food groups are still considered top of the list to avoid to reduce many disease or pain states, including pelvic pain conditions. But in a full elimination diet protocol we include all of the main “allergenic” foods: dairy, gluten, corn, shellfish, soy, eggs, peanuts, tree nuts as well as alcohol and caffeine. Some people may also need to remove nightshades, citrus fruits and sometimes even non-gluten grains and/or legumes.

These foods are removed for 3 to 4 weeks, and at the end of that time you add back only one of the eliminated food groups at a time, eating 2-3 servings per day for 3 to 4 days, making note of any symptoms that arise and then breaking from that food to let the symptoms resolve. The following week you try reintroducing the next food. For those foods you identify as having a reaction to, it’s a good idea to then stay off of them for at least 3 to 6 months, if not longer, to allow for full healing before trying to introduce them again. Many people choose to permanently remove certain foods because they experience such improvements in their health.

When people first think about removing these foods from their diet, especially dairy, gluten and sugar, it can be overwhelming to say the least, because these foods have become such a huge part of the standard North American diet. It helped me stay motivated when I understood a little more of the “why” -

Dairy: Lactose is a sugar in cow’s milk, and casein is the protein found in cow’s milk. People can be sensitive to either or both. Many people who are gluten intolerant are also casein or lactose intolerant. Gluten can damage the part of the intestine that is responsible for producing the enzyme lactase, which is necessary for breaking down lactose. About 75% of adults worldwide are lactose intolerant, and don’t have the digestive enzymes needed to digest this milk sugar, and that means digestive distress. Dairy products are also a dietary source of arachidonic acid, the fat used by the body to produce “bad” prostaglandins, localized hormones which can increase pelvic pain, cramps, and inflammation.

Gluten: Gluten includes several related proteins found in wheat and other grains including spelt, kamut, triticale, barley and rye. It’s estimated that approximately 30 to 40% of the U.S. population has some sensitivity to gluten, in addition to those diagnosed with full blown autoimmune celiac disease. Non celiac gluten sensitivity can over time result in damage to the intestinal lining or mucosa, that then allows undigested food proteins to “leak” through the gut wall into the bloodstream, which can trigger pain, inflammation and autoimmune responses. Even among people who are not sensitive to gluten, eating it triggers the release of a protein produced in the small intestine called zonulin, which again can lead to damaged intestinal lining. Gluten expert Dr. Alessio Fasano has stated that nobody digests these proteins well, and because of this it tends to trigger an inflammatory response.

Gluten intolerance has also been linked to altered estrogen levels. In a 2012 study on women with severe painful endometriosis-related symptoms over 12 months, 75% of the over 200 participants reported statistically significant improvements in painful symptoms when eating gluten-free. (5)

Sugar: Sugar depletes the body’s B complex vitamins and minerals which can worsen muscle tension as well as nervous tension and anxiety. Lack of B vitamins can make it harder for the liver to handle estrogen (important with a number of pelvic pain conditions), and B6 in particular is required for production of good prostaglandins that have relaxant and anti-inflammatory effects. Too many simple carbohydrates and sugar can contribute to indigestion, leaky gut (damage to the lining of the gut), a suppressed immune system, and candida overgrowth. These all mean more inflammation, which can trigger increased pain or symptoms.

FOCUS ON ANTI-INFLAMMATORY FOODS
The good news is there are still lots of delicious, satisfying and nourishing foods left to eat – really! With the right guidance, you will find an elimination diet isn’t the imagined journey of utter deprivation, but leads to discovering and enjoying new foods, losing old cravings, and learning to easily make healthy substitutions. Foods that are well tolerated can be eaten again after only a few weeks.

A focus on choosing mostly whole, nutrient dense, organic foods when possible reduces exposure to toxic chemicals, pesticides and added hormones, so the best choices are:

free range, grass fed meats, wild game, and wild-caught salmon
a wide variety and rainbow colors of veggies
gluten free grains - quinoa, millet, amaranth, tapioca, rice, sorghum
nuts and seeds - coconut, pine nuts, chia seeds, almonds, brazil nuts, walnuts, pecans, nut flours, and meals
legumes
whole fruits, especially berries
healthy fats from olive oil, coconut oil, avocados, ghee, and nut oils
fermented foods like water kefir, sauerkraut, kim chee, other fermented vegetables
herbs and spices
beverages - water, broths, un-caffeinated herbal teas, mineral water, diluted juices, vegetable juices, coconut and other non-dairy milks
sweeteners (to be used sparingly!) - brown rice syrup, raw honey, stevia, fruit sweetener, blackstrap molasses

IS THERE A PELVIC PAIN ELIMINATION DIET?
A basic elimination diet is a great start to tackling your pelvic pain. There are growing resources available via books, group programs, and personal nutrition coaching to lead you through the process, but it’s always best to work with someone who understands pelvic pain conditions and can develop your personalized nutrition plan based on your particular genetic makeup, pelvic pain symptoms, and other health conditions and treatments you’re undergoing, especially in working to identify any personal food sensitivities and recommendations that are outside of a basic elimination diet.

A few examples of how we would tailor a pelvic pain nutritional program would be to also test removing additional foods that are known to increase symptoms for specific conditions:

for women with vulvodynia, avoiding foods that are high in oxalates may reduce symptoms. Some higher oxalate containing foods include spinach, soybeans, grains, legumes, potatoes, almonds, cashews, rhubarb, raspberries, chocolate

for sufferers of interstitial cystitis/painful bladder syndrome avoiding foods like citrus juices, coffee, alcohol, and spicy foods that can cause bladder irritation may be very helpful

in treating endometriosis, we emphasize the balancing of excess estrogen which can fuel the growth of the disease, by removing inflammatory foods and products that tend to imbalance estrogen levels, and emphasizing detoxifying veggies, fruits, fiber and supplements as part of a comprehensive approach to pain reduction and hormone balancing

There is no “one size fits all” diet to treat pelvic pain, but by removing those foods known to promote inflammation and unhealthy digestive functions, identifying and removing foods that create negative symptoms that are particular to each individual, and rebuilding overall health with nutrient dense, anti-inflammatory foods, the body will be more fully supported to heal.

Lark, Susan M., M.D., Fibroid Tumors and Endometriosis Self Help Book. 1995
J Reprod Med. 2005 Oct;50(10):745-758
Human Reprod. 2002;17(10):2715-2724
Reed BD, Harlow SD, Sen A, Edwards RM, Chen D, Haefner HK. Relationship Between Vulvodynia and Chronic Comorbid Pain Conditions. Obstetrics and gynecology. 2012;120(1):145-151. doi:10.1097/AOG.0b013e31825957cf.
Marziali M, Venza M, Lazzaro S, et al. “Gluten- Free Diet: a new strategy for management of painful endometriosis related symptoms?” Minerva Chirurgica. Dec; 67(6) (2012): 499-504

Resources
Cohan, Wendy, RN, The Better Bladder Book. 2011

Morrison, JA, Sullivan, J. A novel approach to treating endometriosis. Alternative & Complimentary Therapies, August 1999, p 225-229.

Petrelluzzi KF, Garcia MC, Petta CA, et al. “Salivary cortisol concentrations, stress and quality of life in women with endometriosis and chronic pelvic pain.” Sep;11(5) (2008): 390-7. doi: 10.1080/10253890701840610.

Segersten, Alissa and Malterre, Tom, MS, CN, The Elimination Diet. 2015

BIO
Susan Tessman is a Certified Nutrition Coach, and Certified by the Integrative Women’s Health Institute as a Women’s Health and Nutrition Coach, with specialized training in chronic pelvic pain, hormone health and pre-conception health. She is dedicated to supporting women suffering with pelvic pain conditions, using a whole person approach that includes nutrition and lifestyle solutions. For more resources on endometriosis and pelvic pain please visit www.susantessman.com

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Pelvic Floor Physical Therapy: What to Expect Part 2

7/11/2016

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Specialized Women's Health Physical Therapy: What ELSE to Expect on your First Visit

Follow up video blog answering some questions from our first video post about what to expect at your very first pelvic floor physical therapy session. Individual experiences will vary. But listening to internationally recognized women's health physical therapist Karen Liberi, MS, MPT, WCS may help relieve some fears and anxiety, especially surrounding the pelvic floor muscle evaluation.

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How to Still Enjoy Intimacy When Sex Hurts

6/10/2016

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How to Still Enjoy Intimacy When Sex Hurts

If you're having difficulties with sexual pain then physical intimacy with your partner is likely a challenge. Here's a few tips for maintaining your sexual relationship even when intercourse may not currently be an option.

Schedule Intimacy

Schedule a weekly date with your partner to maintain emotional intimacy. Set aside a few hours to snuggle as you watch a movie or share an adventure together. Keeping emotionally connected with relieve the tension that can be caused by difficulties surrounding sex. Alternate with your partner to select activities you both enjoy.

Experiment

There are many exiting and fun ways to have sex even if you are unable to have intercourse. Set aside the idea that intercourse is the only "real" way to have sex and intimacy. Open your mind to sharing other types of sexual activity.

Regularly Engage in Sexual Activity That Doesn't Cause Pain

Once you together find several sexual activities you can share in that are fun and exiting but don't cause pain, engage in these activities regularly. Many women lose interest in sex due to the pain they experience. But chances are you will eventually enjoy sex again if you can relax and be willing to engage in sexual activity with your partner that does not cause genital pain, sexual pain, or pelvic pain.

Realize That Intimacy is Two People Working Together to Please Each Other

Intimacy is the result of two people working together to please each other. While some men may say that only intercourse is "real" sex, many admit that they get aroused by making their partner exited, with or without intercourse.

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4 Tips for Your Exercise Routine

5/5/2016

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EXERCISE ROUTINE TIPS FOR THOSE WITH PELVIC PAIN

4 Tips for Exercising {with Pelvic Pain} | PainDownThere.com

1. Be Cautious About Routine Exercises You May Already Be Doing

The pelvic region has many more joints, muscles, and ligaments than you may imagine. Some exercise practices such as the use of stationary bicycles and stair climbers, may otherwise be healthy for you, but if you experience sexual and pelvic pain these types of exercises might cause extra stress and spasm.

"Toning up" may actually be a "sexual downer" on body parts that need to be the most relaxed and comfortable for those intimate moments.

2. Seats and Clothing

Find the softest, most pliable seat possible and wear loose-fitting clothes when riding a bicycle, motorcycle, or scooter. Better yet, consider giving up these activities. The pressure against your already sensitive genital area can cause symptoms to flare up.

3. Give Up the Attitude of "Playing Through the Pain"

While coaches often urge athletes young and old to "play through the pain", it's vital to abandon this attitude when it comes to enduring painful sex as an adult. Please don't believe that you must have sex to please your partner despite the pain and if you don't something is fundamentally wrong with you. Nothing could be further from the truth. A loving partner would never want to cause such suffering.

4. See a Pelvic Floor Physical Therapist

More and more physical therapists (PTs) are incorporating pelvic pain treatment into their practice as the urgency of effectively treating sexual pain increases. A growing number of doctors consider pelvic floor physical therapy a vital component of a complete treatment plan for sexual pain. Specialized pelvic floor PTs utilize various methods to release trigger points in the body. Trigger points develop through contraction or spasms in the muscle groups surrounding the vagina, bladder, and lower bowel. Using manual pressure, biofeedback, and other techniques these health care providers can often aid sufferers. Patients are eventually given techniques to maintain wellness at home.

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3 Myths About Vaginismus

4/26/2016

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Vaginismus is a condition that affects the muscles of the pelvic floor and involves involuntary spasming or clenching of the pelvic musculature. Typically this reactive tightening of the muscles is in response to insertion or the attempt of insertion of an object into the vagina, making vaginal intercourse painful and sometimes impossible. Thankfully, this condition is becoming more and more recognized by the mainstream media. But coming along with it are some misconceptions about vaginismus that we'd like to clear up.

Myth #1: Kegels Cure Vaginismus

Kegels, done correctly, are a great strengthening technique for the muscles of the pelvic floor for many women and men. However, someone who is struggling with vaginismus is not a good candidate to begin practicing kegels. While kegels may be introduced later on to help the overall pelvic and core musculature function together during certain body movements, they should be avoided at first. The focus of treatment should instead be on the ability to consciously recognize and relax the pelvic floor muscles. It is best to receive this treatment under the direction of a specialized women's health physical therapist who can guide you through imagery and biofeedback techniques. Also, consider our physical therapy digital download chapter packages to assist you at home.

Myth #2: Vaginal Dilators are Used to 'Stretch' the Muscles

Dilators are an incredibly helpful tool for those with vaginismus. Their function in the treatment process, however, isn't so much to "stretch" the tight muscles of the pelvic floor. The pelvic floor muscles are already quite capable of stretching far beyond what is needed for sexual intercourse (think, delivering a baby). The problem with vaginismus is that the central nervous system (the brain and all its related systems including the spinal cord and nerves) is sending signals to the pelvic musculature to brace itself for what it considers or 'remembers' to be painful: vaginal penetration. So dilators work by desensitizing the central nervous system (see Myth #3 for more on this) and by providing trigger point release (intentional pressure to points of muscular tension for the relief of pain, much like in your neck or shoulders). To learn more about the science of chronic pelvic pain and the use of dilators in the treatment of vaginismus, purchase the DVD Healing the Pain Down There: A Guide for Females with Persistent Genital & Sexual Pain. We recommend dilators from Syracuse Medical Devices as they are made of medical grade material and have a consistent length. It is important to have a long enough dilator to be able to reach the second layer of the pelvic floor musculature even with the smallest dilator in diameter.

Myth #3: You Just Have to Try to Relax and Keep Practicing Sex

If you continue doing as you have been doing - having sex that is painful, then setting yourself up in that same environment with your partner will actually perpetuate or re-enforce the pain - because your mind is already anticipating the pain - it is a known response and you cannot just "force" a relaxation response instead. But if we remove the “red flags” from the brain and place YOU IN CONTROL using the dilators, we can re-train the brain to realize that there doesn’t need to be a “fight or flight response”, we can begin to “unwind” the nervous system. When you start with an extra small dilator and can insert and move it and do self stretches with low to no pain - then the brain starts to realize that - OK - that wasn’t so bad and the secondary responses of muscular tensions ease also allowing for less pain and your overall confidence level with repeated successful sessions with the dilator allows you to become ready for return to intercourse with low to no pain. It is important that you abstain from intercourse (not intimacy) during dilator sessions until you can progress to the proper size. So essentially what happens is you change the perception in your brain about the health of your vagina, decreasing the sensitivity of your nervous system to keep the muscle tension in check to help achieve a good end result.

Content Providers of this Article, paindownthere.com, and video guide series for Healing the Pain 'Down There':

Robert Echenberg, MD
Karen Liberi, MS, MPT, WCS
Alexandra Milspaw, PhD, LPC

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How To Naturally Quiet Penetration/Entrance Pain

How To Naturally Quiet the #1 Cause of Penetration/Entrance Pain (In Reproductive Aged Women)

SELF CARE TIPS FOR WOMEN WITH SEXUAL PAIN

1. CHANGE YOUR PAD OFTEN

2. USE UNSCENTED LAUNDRY PRODUCTS

3. WASH YOUR VAGINAL AREA WITH WATER ONLY

4. BEND OVER TO RINSE OUT SHAMPOO

5. WIPE THE RECTAL AREA PROPERLY

WHY DO I HAVE VAGINAL PAIN? A SCIENTIFIC LOOK AT THE VULVAR VESTIBULE

10 CONDITIONS COMMONLY ASSOCIATED WITH SEXUAL PAIN

1. Fibromyalgia, Migraine, and other Chronic Pain Conditions

2. Interstitial Cystitis (IC)

3. Irritable Bowel (IBS)

4. Lichen Sclerosis

5. Myofascial Pain Syndrome

6. Pelvic Endometriosis

7. Pelvic Floor Dysfunction

8. Previous life-long Pelvic Trauma

9. Generalized Vulvodynia

10. Vulvar Vestibulodynia (Vestibulitis)

Provoked Vulvodynia

Provoked Vulvodynia
An Update from The Journal for Nurse Practitioners
Volume 12, Issue 8, September 2016
Page 530

NUTRITIONAL THERAPY FOR PELVIC PAIN

Pelvic Floor Physical Therapy: What to Expect Part 2

How to Still Enjoy Intimacy When Sex Hurts

4 Tips for Your Exercise Routine

1. Be Cautious About Routine Exercises You May Already Be Doing

2. Seats and Clothing

3. Give Up the Attitude of "Playing Through the Pain"

4. See a Pelvic Floor Physical Therapist

3 Myths About Vaginismus

Myth #1: Kegels Cure Vaginismus

Myth #2: Vaginal Dilators are Used to 'Stretch' the Muscles

Myth #3: You Just Have to Try to Relax and Keep Practicing Sex

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Blog

How To Naturally Quiet the #1 Cause of Penetration/Entrance Pain (In Reproductive Aged Women)

1. CHANGE YOUR PAD OFTEN

2. USE UNSCENTED LAUNDRY PRODUCTS

3. WASH YOUR VAGINAL AREA WITH WATER ONLY

4. BEND OVER TO RINSE OUT SHAMPOO

5. WIPE THE RECTAL AREA PROPERLY

1. Fibromyalgia, Migraine, and other Chronic Pain Conditions

2. Interstitial Cystitis (IC)

3. Irritable Bowel (IBS)

4. Lichen Sclerosis

5. Myofascial Pain Syndrome

6. Pelvic Endometriosis

7. Pelvic Floor Dysfunction

8. Previous life-long Pelvic Trauma

9. Generalized Vulvodynia

10. Vulvar Vestibulodynia (Vestibulitis)

​Provoked VulvodyniaAn Update from The Journal for Nurse PractitionersVolume 12, Issue 8, September 2016Page 530

1. Be Cautious About Routine Exercises You May Already Be Doing

2. Seats and Clothing

3. Give Up the Attitude of "Playing Through the Pain"

4. See a Pelvic Floor Physical Therapist

Myth #1: Kegels Cure Vaginismus

Myth #2: Vaginal Dilators are Used to 'Stretch' the Muscles

Myth #3: You Just Have to Try to Relax and Keep Practicing Sex

Author

Archives

Categories

Subscribe

Provoked Vulvodynia
An Update from The Journal for Nurse Practitioners
Volume 12, Issue 8, September 2016
Page 530