Off the Press! The Pink Pill and Other News

In Female Pelvic Pain by Stephanie Prendergast3 Comments

By Stephanie Prendergast

It has been an eventful few weeks in pelvic health news! We’ve summarized the top stories and included our commentary.

“Pelvic pain may be common among reproductive-age women, NIH study finds.”

From the National Institute of Health

Article summary:

  1. Pain reports were highest for women with endometriosis, however of those without any pelvic condition also reported a high degree of ongoing pain or pain recurring during their menstrual cycle.
  2. Many women are experiencing but not reporting some form of pelvic pain.
  3. Gynecologists are being encouraged to ask their patients during routine visits if they are experiencing pain, as well as the type and location of pain, and offer treatment as appropriate. Similarly, women need to report pelvic pain.” Researchers suggest physicians consider asking about pain, even during routine visits. A high proportion of reproductive-age women may be experiencing pelvic pain that goes untreated, according to a study by researchers from the National Institutes of Health and the University of Utah School of Medicine, Salt Lake City.”

The majority of the people that I treat have pelvic pain. When I first saw this study, I scoffed because of the ‘duh’ factor.  As I thought more about my own gynecology visits and the stories my patients tell me, I realized this seemingly oversimplified information is exactly what gynecologists and women with pelvic pain need to hear. The fact that a 2015 study from our National Institute of Health is encouraging basic communication between physicians and patients accurately reflects the poor quality of care people with persisting pain frequently encounter.

Thankfully, there has been exponential increases in research on pelvic pain and a growing number of medical professionals committed to treating it. Drs Gyang, Hartman, and Lamvu recently published an article that is a great resource for gynecologists wanting to learn more about pelvic pain. Here is the abstract:

“Musculoskeletal causes of chronic pelvic pain: what a gynecologists should know should know”

Article summary:

Ten percent of all gynecologic consultations are for chronic pelvic pain, and 20% of patients require a laparoscopy. Chronic pelvic pain affects 15% of all women annually in the United States, with medical costs and loss of productivity estimated at $2.8 billion and $15 billion per year, respectively. Chronic pelvic pain in women may have multifactorial etiology, but 22% have pain associated with musculoskeletal causes. Unfortunately, pelvic musculo- skeletal dysfunction is not routinely evaluated as a cause of pelvic pain by gynecologists. A pelvic musculoskeletal examination is simple to perform, is not time-consuming, and is one of the most important components to inves- tigate in all chronic pelvic pain patients. This article describes common musculoskeletal causes of chronic pelvic pain and explains how to perform a simple musculoskeletal examination that can be easily incorporated into the gynecologist physical examination.

Reference (Obstet Gynecol 2013;121:645–50)

Despite the recent advances, a knowledge gap exists between pelvic pain specialists, general medical providers, and patients. Societies such as the International Pelvic Pain Society, the International Society for the Study of Women’s Health, the APTA’s section on Women’s Health and The international Society for the Study of Vulvovaginal Disease are working hard to improve education and awareness, and narrow this gap, which brings us to our next news worthy item of the week.

The International Consensus Conference on Vulvodynia Nomenclature

In April, Dr. Andrew Goldstein organized a “Vulvar Pain Think Tank”  with the mission of redefining and improving the 2003 definition of vulvar pain. Since 2003, studies have been conducted on possible causative factors and treatment options for women with vulvar pain. Expert researchers and clinicians were gathered and charged with the task of improving the nomenclature based on the evidence. Representatives from IPPS, ISSVD, ISSWSH, NVA and ACOG reached a consensus by the end of the meeting.

The next step was to get the new nomenclature approved by the ISSVD, IPPS, and NVA. Slight modifications were made to our initial proposal. We are extremely pleased to announce that as of this week, all three societies UNANIMOUSLY approved our new definition and categorization of vulvar pain! As a group we believe this is an important advancement for the diagnosis and management of persistent vulvar pain.

On a personal note, this conference was an intimidating but extremely stimulating event in my professional career. I am honored to have been apart of it. If you would like to read more about it check out my blog post titled “What is Vulvodynia?”.

Vulvar pain interferes with a woman’s sex life, and so does a lack of sexual desire, which brings us to the next newsworthy item of the week.

US Food and Drug Administration approves The Little Pink Pill

Similar to pelvic pain, female sexual dysfunction is under-reported by woman, misunderstood by medical professionals, and is associated with embarrassment and quality of life issues. Last week, the US Food and Drug Administration approved the first drug authorized to treat female hypodesire disorder, flibersarin. The approval of this drug is causing an uproar between its supporters and antagonists.


  1. Early on, the media inaccurately called this drug “Female Viagra”.  It’s not.  Drugs such as sildenafil (Viagra)  have a transient effect on enzymes that allow erection by causing smooth muscle relaxation when sexually stimulated. It is taken before suspected sexual contact. Flibersarin works on neurotransmitters in the brain and needs to be taken daily. It works on the same neurotansmitters that are associated with anxiety and depression.
  2. A second battle is the ‘ gender discrimination’ vs Big Pharma controversy. Currently there are 27 medications on the market for erectile dysfunction and until now, there have been zero for female sexual dysfunction. Opponents suggest the creators of flibersarin invented ‘female sexual dysfunction’ as a  money making disorder and that it does not really exist. Similar to pelvic pain, many general medical professionals are not aware of how to diagnose or treat the disorder. Women get told things like “it’s all in your head” or “drink a glass of wine”.  Other opponents recognize female sexual dysfunction as a disorder but question the efficacy of the drug as treatment. Supporters attack both groups of opponents on the basis of not supporting women. It is important to recognize that sexually savvy medical professionals may  not support the drug because of science, not anti-feminism.
  3. The drug was tested on 28 men and 2 women. Side effects include a severe drop in blood pressure that exponentially increases with alcohol use. I am not sure why a drug that is only for women was tested mostly on men. Aside from that minor issue, women taking the medication cannot have even one drink, ever,  if they would like to remain conscious.

I am an advocate for women suffering from sexual dysfunction, whether it is caused by pelvic pain or a desire disorder. Both pelvic pain and hypodesire disorder are misunderstood, underreported multifactorial syndromes involving  both physiological and emotional components. As medical professionals it is important to differentially diagnose the sources of each person’s disorder and customize an appropriate treatment plan for that particular person. It is as short-sighted to believe a ‘pink pill’ is effective for all women suffering from  desire disorders as it is to believe a single pill can cure vulvar pain.


The bottom line is women need to report their pelvic pain, their providers need to ask about it and either treat them or help them find someone who can. If you are looking to find a provider that specializes in pelvic pain, please see this blog post to help you find someone in your area that can help.

“Thank-you and Good Night”.

Stephanie Prendergast, MPT

stephanieStephanie grew up in South Jersey, and currently sees patients in our Los Angeles office. She received her bachelor’s degree in exercise physiology from Rutgers University, and her master’s in physical therapy at the Medical College of Pennsylvania and Hahnemann University in Philadelphia. For balance, Steph turns to yoga, music, and her calm and loving King Charles Cavalier Spaniel, Abbie (Abbie is a daily fixture at PHRC Los Angeles). For adventure, she gets her fix from scuba diving and global travel.


What are pelvic floor muscles?

The pelvic floor muscles are a group of muscles that run from the coccyx to the pubic bone. They are part of the core, helping to support our entire body as well as providing support for the bowel, bladder and uterus. These muscles help us maintain bowel and bladder control and are involved in sexual pleasure and orgasm. The technical name of the pelvic floor muscles is the Levator Ani muscle group. The pudendal nerve, the levator ani nerve, and branches from the S2 – S4 nerve roots innervate the pelvic floor muscles. They are under voluntary and autonomic control, which is a unique feature only they possess compared to other muscle groups.

What is pelvic floor physical therapy?

Pelvic floor physical therapy is a specialized area of physical therapy. Currently, physical therapists need advanced post-graduate education to be able to help people with pelvic floor dysfunction because pelvic floor disorders are not yet being taught in standard physical therapy curricula. The Pelvic Health and Rehabilitation Center provides extensive training for our staff because we recognize the limitations of physical therapy education in this unique area.

What happens at pelvic floor therapy?

During an evaluation for pelvic floor dysfunction the physical therapist will take a detailed history. Following the history the physical therapist will leave the room to allow the patient to change and drape themselves. The physical therapist will return to the room and using gloved hands will perform an external and internal manual assessment of the pelvic floor and girdle muscles. The physical therapist will once again leave the room and allow the patient to dress. Following the manual examination there may also be an examination of strength, motor control, and overall biomechanics and neuromuscular control. The physical therapist will then communicate the findings to the patient and together with their patient they establish an assessment, short term and long term goals and a treatment plan. Typically people with pelvic floor dysfunction are seen one time per week for one hour for varying amounts of time based on the severity and chronicity of the disease. A home exercise program will be established and the physical therapist will help coordinate other providers on the treatment team. Typically patients are seen for 3 months to a year.

What is pudendal neuralgia and how is it treated?

Pudendal Neuralgia is a clinical diagnosis that means pain in the sensory distribution of the pudendal nerve. The pudendal nerve is a mixed nerve that exits the S2 – S4 sacral nerve roots, we have a right and left pudendal nerve and each side has three main trunks: the dorsal branch, the perineal branch, and the inferior rectal branch. The branches supply sensation to the clitoris/penis, labia/scrotum, perineum, anus, the distal ⅓ of the urethra and rectum, and the vulva and vestibule. The nerve branches also control the pelvic floor muscles. The pudendal nerve follows a tortuous path through the pelvic floor and girdle, leaving it vulnerable to compression and tension injuries at various points along its path.

Pudendal Neuralgia occurs when the nerve is unable to slide, glide and move normally and as a result, people experience pain in some or all of the above-mentioned areas. Pelvic floor physical therapy plays a crucial role in identifying the mechanical impairments that are affecting the nerve. The physical therapy treatment plan is designed to restore normal neural function. Patients with pudendal neuralgia require pelvic floor physical therapy and may also benefit from medical management that includes pharmaceuticals and procedures such as pudendal nerve blocks or botox injections.

What is interstitial cystitis and how is it treated?

Interstitial Cystitis is a clinical diagnosis characterized by irritative bladder symptoms such as urinary urgency, frequency, and hesitancy in the absence of infection. Research has shown the majority of patients who meet the clinical definition have pelvic floor dysfunction and myalgia. Therefore, the American Urologic Association recommends pelvic floor physical therapy as first-line treatment for Interstitial Cystitis. Patients will benefit from pelvic floor physical therapy and may also benefit from pharmacologic management or medical procedures such as bladder instillations.

Who is the Pelvic Health and Rehabilitation Team?

The Pelvic Health and Rehabilitation Center was founded by Elizabeth Akincilar and Stephanie Prendergast in 2006, they have been treating people with pelvic floor disorders since 2001. They were trained and mentored by a medical doctor and quickly became experts in treating pelvic floor disorders. They began creating courses and sharing their knowledge around the world. They expanded to 11 locations in the United States and developed a residency style training program for their employees with ongoing weekly mentoring. The physical therapists who work at PHRC have undergone more training than the majority of pelvic floor physical therapists and as a result offer efficient and high quality care.

How many years of experience do we have?

Stephanie and Liz have 24 years of experience and help each and every team member become an expert in the field through their training and mentoring program.

Why PHRC versus anyone else?

PHRC is unique because of the specific focus on pelvic floor disorders and the leadership at our company. We are constantly lecturing, teaching, and staying ahead of the curve with our connections to medical experts and emerging experts. As a result, we are able to efficiently and effectively help our patients restore their pelvic health.

Do we treat men for pelvic floor therapy?

The Pelvic Health and Rehabilitation Center is unique in that the Cofounders have always treated people of all genders and therefore have trained the team members and staff the same way. Many pelvic floor physical therapists focus solely on people with vulvas, this is not the case here.

Do I need pelvic floor therapy forever?

The majority of people with pelvic floor dysfunction will undergo pelvic floor physical therapy for a set amount of time based on their goals. Every 6 -8 weeks goals will be re-established based on the physical improvements and remaining physical impairments. Most patients will achieve their goals in 3 – 6 months. If there are complicating medical or untreated comorbidities some patients will be in therapy longer.


  1. I believe pelvic pain is a multifaceted syndrome and that the whole person must be treated and included in decision making.

    Thank you for your advocacy and all that you have done for all of us. We need a voice and a village.

  2. This drug definitely needs work. While it would be great for there to be a pill to help women with these issues, it needs to be one that’s safe for them. I’m also wondering why the drug was tested on men so much too.

    1. Hello Jordan,

      We agree with you. It is difficult to know why they tested on men, but we assume that the hormonal differences in testosterone could have been a factor.



Leave a Comment