Early Trauma and Its Effect on Chronic Urogenital Pain

In Pelvic Floor Physical Therapy by Elizabeth Akincilar6 Comments

By: Elizabeth Akincilar, PHRC Cofounder

Another October, another International Pelvic Pain Society Annual Scientific Meeting has come and gone. This year, we gathered in Toronto, Canada to learn about the latest and greatest in the world of pelvic pain. It seemed fitting that the first lecture of the general meeting would discuss possible early contributors to chronic urogenital pain. 

Dr. Julie Christianson, PhD is an associate professor at the University of Kansas Medical Center. Her research focuses on understanding the influence of early life stress on the development of comorbid chronic pain and affective disorders later in life. Therefore, she presented her research on early trauma and its effects on chronic urogenital pain.

Dr. Christianson began by reviewing the results of the 2012 Kaiser Adverse Childhood Experiences (ACES) Study. This study revealed that children who experienced more adverse experiences, or had higher ACE scores, as adults, their morbidity and mortality was increased. She presented research by Schrepf, et al, that concluded that women with chronic pelvic pain that had higher ACE severity were associated with greater depression, anxiety, perceived stress, pain catastrophizing, functional symptoms, widespreadness of pain, fatigue, poor sleep, worse perception of well-being, which all leads to less symptomatic improvement over time. Interestingly, the same was not true for their male counterparts. Another study by Gupta, et al presented data that suggests that early life trauma predisposes females, in particular, to increased perception of pain following subsequent trauma. 

Dr. Christianson’s research utilized a mice model to further study the effect of early life trauma on pelvic pain. The study introduced two “stressors” to female baby mice. The first stressor was separating the pups from their mother for three hours per day for 21 days straight. The second stressor was causing neonatal vaginal irritation, or essentially diaper rash, in the pups. After these two stressors, they tested the pups pelvic organ sensitivity. After the vaginal irritation, they noted specific and widespread hypersensitivity. After the maternal separation, they noted urogenital-specific organ hypersensitivity. In the group that was separated from their mother, they further stressed them as adults with a water avoidance test. Essentially, they made it difficult for them to avoid falling in water. In this group, they found that their urogenital-specific organ hypersensitivity was exacerbated. Next they introduced a treatment intervention, which was exercise. They showed that when given the opportunity to exercise, the stressed mice didn’t exercise as much as the mice that did not undergo the stressors. They also found that the mice that did exercise showed a decrease in bladder sensitivity. The mice that didn’t exercise urinated more frequently when compared to the mice that did exercise. Upon further examination, they found that the mice that exercised had decreased cortisol levels and mast cell degranulation. They concluded that these early life stress or insult models provide clinically-relevant outcomes for testing pharmacological and/or lifestyle interventions for the treatment of chronic pelvic pain. 

PHRC’s blog has tackled various lifestyle interventions that can play a crucial role in the treatment of chronic pelvic pain. In a previous blog, guest blogger, Lorraine Faehndrich, discusses negative thinking and how it affects pain. One of PHRC’s physical therapists, Maryssa Steffen, discusses the importance of sleep in this blog, and how it can positively affect pain. 

I would like to thank Dr. Christianson and her team for their commitment to studying chronic pain and helping our medical community find more effective treatment interventions for this patient population. 


  1. Thank you for all the information you send us. It’s very helpful. I am wondering what is meant by early trauma. Do you mean sexual abuse? Or trauma from stress?

    1. I certainly fit the profile for ACE. I suffer from multiple pelvic issues. There are many adverse childhood events besides sexual abuse.

  2. I wish we would discuss pudendal nerve Entrapment and pudendal neuralgia, how it effects you sexually emotionally, your relationships with spouse family and friends. The lack of research in Canada and that the only place that was studying this was Wasser Pain Management Clinic which had now been dismantled. They brought a Dr. to run clinic before closing whose mandate was to remove all opioids and then us with this disease were left with no pain management, no Doctor and no quality of life. We also have no one to talk to that has same disease so we do not feel alone.
    Removing all opioids, lowering quality of life to live with this extreme pain caused suicide cases to increase. Nerve pain is not getting the level of reseTvh we need, Canada is doing no research and anytime we go to Doctors, no one knows it, nerve disorders must be part of the curriculum with Dr’s so we are not viewed as psychiatric patients, this pain is very real and some days pain is even worst where you feel like giving up ,this is not no life for me and my family,. We need to be part of the conversation.

  3. As always I’m up at 1 a.m. searching for any information about my condition that might help me when I stumbled onto this page and just had to comment.
    I have suffered for 58 years from what has finally been diagnosed last year as Pundendal neuralgia.
    This came as a result of being kicked down a flight of outside cement stairs by my mother at age 2 along with daily beatings throughout my childhood. The pain, at this moment is an 8 as always and that’s with a 10-325 percocete . I used to also be on 120 mg morphine per day for this but I quit w/o telling my doctor until I quit. I’m so tired of the pain and the pills and have many times thought of getting extreme by chopping it off or worse, doing myself in.
    As a child I was in so much pain that I couldn’t sit still and at times I’d just leave school so the schools tested me several times to see if I had learning issues but what they found was that I have an IQ at the lowest of 148 and the highest being 168. I was in so much pain that I just couldn’t sit or concentrate long enough to do any school work and quit at age 13 because sitting in class was so painful and therefore I never achieved my truest potential. Looking back one of the worst parts was that I was so embarrassed to tell anyone, I mean how does a child in the 60’s tell anyone that his member is in so much pain? This I feel today would still be an issue with so many boys denying them help.
    I don’t know if you can do anything with what I’ve just told you but if this helps others to understand the seriousness of this pain I’m all so glad to share.
    I can say this, at 60 I’m so glad the end is not too far away.

    1. Hi Christopher- It sounds like you could really benefit from seeing a pelvic floor physical therapist. That is a long history of pain that you have described. If you would like to get in touch to see how we could assist, you can request a free 15 min consult with us by filling out the form located here at this link https://pelvicpainrehab.com/consult-2/

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