2014 IPPS Conference Must-Read Nuggets: Part II

In Pelvic Floor Physical Therapy by Stephanie Prendergast5 Comments

ipps

Last week we brought you our first round of “must-read” nuggets from the 2014 IPPS Conference in Chicago, this week we’re offering up the second round.

Allison heard Andrew Goldstein, M.D. discuss The Role of Combined Hormonal Contraceptives and Vulvodynia.

Dr. Goldstein argues that the use of birth control pills could be linked to the genesis of female pelvic pain. The vulvar vestibule shares the same embryologic origin as the male urethra, and the Bartholin’s and Skene’s glands are the female counterpart of the male Cowper’s and prostate glands, he pointed out. The implication of this information is that these are androgen dependent glands and by taking oral contraceptives there is an anti-androgenic effect.

Specifically, by taking birth control pills there is ovarian suppression of testosterone production and an increased production of sex hormone-binding globulin which leads to a greater than 75% decrease in bioavailable testosterone.

Because of this decreased arousal, libido, orgasm, and frequency of intercourse often occur, he said. Physical changes that can occur with the anti-androgenic effects of birth control pills include decreased thickness of the labia, size of the clitoris, diameter of the introitus, and vaginal lubrication. Obviously, not everyone who uses birth control pills gets pelvic floor pain; however, Dr. Goldstein makes a strong argument against the use for women that are at risk for or experience pelvic pain. To read more about Dr. Goldstein’s arguments, click here.

Stephanie heard Dr. Jeannette Potts’ lecture titled “The Problem is NOT the Prostate!”

In a lively presentation, Dr. Jeannette Potts explained why the term “Prostatitis” and the Prostatitis classification system has been a disservice to the vast majority of men suffering from pelvic pain.

She demonstrated this point with four studies showing that men with and without lower urinary tract symptoms had similar test results upon culture showing that prostate inflammation or infection is not the source of the symptoms. Furthermore, symptomatic men treated with antibiotics did not have any significant benefit over men treated with a placebo medication.

She went on to argue that as early as 1977 research showed that pelvic floor myalgia was found in men who were previously diagnosed with chronic prostatitis. Finally, in 2009, a multi-center clinical trial revealed that pelvic floor physical therapy is an effective treatment for men suffering from pelvic pain. Dr. Potts’ presentation reiterated why we have to STOP calling the field “women’s health”!

Stephanie also heard Jason Kutch’s, PhD, talk titled, “Altered Brain Motor Control Networks in Men with CPP: A Trans-MAPP Neuroimaging Study”

The MAPP, (MAPP stands for “multidisicplinary approaches to study chronic pelvic pain) clinical trials are multi-site investigations looking at symptoms, biomarkers, quantitative sensory testing, and neuroimaging (functional MRI brain scans) associated with pelvic pain.

His group hypothesized that brain regions that activate the pelvic floor would have altered functional connectivity with other critical brain regions in men with chronic pelvic pain syndrome (CPPS). Using fMRI brain scans, his group was able to determine that the medial wall of the precentral gyrus is associated with pelvic floor function. People with pelvic pain demonstrated fMRIs scans that differed from the controls.

What does this mean?

This means that we may be able to start using fMRI brain scans to diagnose pelvic pain. It also means that technologies directed at correcting abnormal brain processing mechanisms, such as Transcranial Magnetic Stimulation (TMS) may be a therapeutic option for people suffering from pelvic pain.

The MAPP study results re-confirmed that pelvic floor muscle hypertonus can cause lower urinary tract symptoms.  However, Dr. Kutch pointed out that the origin of altered pelvic floor muscle tone remains unknown.

Lastly, Rachel heard Dr. Leah Millheiser from Stanford University talk about sexual function in patients with chronic pelvic pain. Dr. Millheiser began her lecture discussing the importance of knowing the primary cause of the sexual dysfunction. She pointed out that fixing chronic pain may not necessarily mean that one fixes the sexual dysfunction. However, that sexual function may improve with treatment of chronic pelvic pain.

She discussed the cycle that often occurs when a patient has an expectation of pain. It usually leads to avoidance of intercourse and then a loss of interest in sex in general. She discussed a multitude of treatment options including pelvic floor physical therapy and even stated: “I could not do what I do without pelvic floor physical therapy.”

Dr. Millheiser also pointed out the importance of acknowledging that sexual intercourse is not the only way to be physically intimate with one’s partner and the importance of discussing other options with patients.

We hope you enjoyed reading our coverage of the conference as much as we enjoyed providing it! Were there any lectures that stood out for you? Would you like us to cover any of the topics included in our roundups in more detail here on our blog? Let us know in the comment section below!

All our best,

The PHRC Team

Comments

  1. Any news on better medications or interstim for pudendal neuralgia and pelvic floor pain in general?
    Thanks
    ricki

    1. Author

      Hi Ricki,

      Chris Payne, MD did present evidence to support Interstim trials for patients with PBS/IC. Next year we may hear more information on this topic. There was a panel discussion around the usage of opiates for treatment of pelvic pain. I will post the questions to Facebook for the conference attendees to summarize the verdict. Thank-you for your great questions!

  2. Healthy at 42 when pain began, seemed out of the blue! …10 years still with chronic pelvic pain on right side near joint at pubic bone. Poor husband suffering along side me trying to care for me, I’m unable to work… he’s never given up on a cure. Exhausted all avenues for help…gave into fear of the pain & the unknown and begged for exploratory/diagnostic laparoscopy surgery in 2012… lost 2 organs; appendix & rt ovary, as surgery became a partial hysterectomy. (Very rough surgery! Tough recovery. Not at all as simple as gallbladder laparoscopic surgery many years earlier.) Please continue believing in us strong, nurturing, loving women, suffering in this terrible pain. Our families bewildered and suffering with us. Beautiful lives being destroyed with no answers. Thank you. Kim – ps – my quick health history: very strong & healthy. Took oral birth control in yearly twenties (early 1980)for 5 years. Very healthy up to birth of only child in 1991. Difficult birth … left with tailbone pain, but went right back to full-time work. 1996 stomach pains led to gallbladder removal, very quick recovery and right back to work, but suffered chronic diarrhea for a year. No other health issues. 2003 began having indigestion … took Nexium for a year. 2004 had an “attack” like being stabbed, lower rt stomach to rt pubic bone area…and that very pain remains to this day. Seen many doctors & specialists and continued to see very beloved family doctor through it all. Pain brought on sleep disorder and high blood pressure, for which I take medications… 10 years now. Still seeking help.

    1. Author

      Hello Kim,

      I am sorry to hear about your situation. I may be able to recommend a pelvic floor therapist that can help you. Where are you located?

      All my best,

      Malinda

  3. Jim,Thanks for the great article. I’ve been folwnliog you on Canadian Finance Blog. Today my dad emailed me a link to your article and said I should check it out.

Leave a Comment