Recognizing Pelvic Pain Awareness Month

By PHRC TEAM

May is recognized worldwide as Pelvic Pain Awareness Month, an observance that aims to raise awareness about pelvic pain and encourage education, research, and advocacy. Despite the prevalence of this condition, it often remains underdiagnosed and undertreated due to lack of awareness and understanding. The entire team at the Pelvic Health and Rehabilitation Center is committed first and foremost to using evidence-based evaluation and treatments. Beyond our desire to help our patients we help the community in other ways.

Did You Know?

Less than 60% of OBGYNs feel comfortable diagnosing and treating vulvodynia? Most do not receive ANY specialized training in medical school regarding sexual health and pain (1).
Urologists do not receive training about pelvic pain in medical school.
Pelvic floor physical therapy is first line treatment for people with pelvic pain and those of us at PHRC will continue to improve awareness and training for those who are interested!

Awareness and Education

We understand all too well the barrier people face trying to get help for their symptoms. We promise, it is getting better but we have a long way to go so here is what we are doing this year to help. We actively engage in education via community outreach, educational workshops, and seminars for patients and providers. PHRC cofounder Elizabeth Akincilar is co-director of an organization, the Jackson Clinics Foundation, bringing formalized pelvic floor physical therapy education to Kenya! Many members of the PHRC clinical team donated their time to help develop the curricula and to travel to teach the students. PHRC cofounder Stephanie Prendergast and PHRC director of education Jandra Mueller teach via the International Pelvic Pain Society (IPPS) and The International Society for the Study of Women’s Sexual Health

Over the next 2 years students will experience a robust online curriculum and 6 in person segments with expert teachers from the US. But the goal is to have this program independently run by Kenyans. Please visit their GoFundMe directly for more information about the program and/or donating. This gofundme will raise money to support our volunteer TAs and also go to purchase a few teaching supplies (books, models) that we would like to provide to the students to enhance their learning.

Understanding Pelvic Pain

A number of diagnoses are associated with the general term ‘pelvic pain’ but here are the most common:

Vulvodynia/Vestibulodynia/Vaginismus
Interstitial Cystitis/Painful bladder syndrome (IC/PBS)
CPPS/Non-bacterial Chronic Prostatitis (CP/CPPS)
Pudendal Neuralgia
Endometriosis
Lichen Sclerosus and Planus
PolyCystic Ovarian Syndrome (PCOS)
Pelvic Venous Disorders (PeVD)

While all of the diagnoses have different etiologic factors, most patients with these diagnoses have pelvic floor dysfunction and this dysfunction contributes to their pain or symptoms. The good news is that pelvic pain is treatable! Pelvic floor physical therapy is recommended as the first-line treatment (Torosis, et. al, 2024).

PHRC and Pelvic Pain Awareness Month

In honor of pelvic pain awareness month this year, the Pelvic Health and Rehabilitation Center hosted a fundraiser for two important nonprofit organizations: Tight Lipped, a grassroots patient-led advocacy group raising awareness to medical providers about the importance of pelvic pain; and Riley Hooper, a documentarian film-maker who is raising awareness about a specific condition called ‘neuroproliferative Vestibulodynia’ with her film, Vestibule, sharing her story. We also published our first e-book Vulvodynia, Vestibulodynia and Vaginismus!! All registrants received a copy of our book which is full of resources. Vulvar experts Drs. Jill Krapf, Rachel Rubin, and Sarah Cigna joined for a Q&A, all proceeds go to Tight Lipped and Vestibule. If you are interested in donating please visit: Tight Lipped Donations, Vestibule Donations.

In addition to fundraising and volunteer work we also help commercial and academic institutions recruit for their projects. Check out a cool project regarding the effects of surfing on pelvic pain, led by Jason Kutch, PhD at USC! If you experience pelvic pain, this blog is for you!

Research Opportunity

Overall Aims for this project: “In this project, we will use a randomized controlled trial to test the hypothesis that repetitive transcranial magnetic stimulation (rTMS) directed at a cortical site that controls pelvic floor muscles can reduce pain, and improve brain and muscle activity in women with IC/BPS.” (USC 2024).

Do you experience unwanted and/or persistent feelings of genital arousal (Persistent Genital Arousal Disorder/Genito-Pelvic Dysesthesia)? You might be eligible to participate in the Sexual Health Implications of PGAD Study (SHIPS)! To participate, or to find out more, please contact us directly at [email protected].

The Goal: To learn about the role of the group in pelvic pain patients’ experience of their condition, treatment, and social identities. Interested in participating? Please contact [email protected]. This research has been approved by the NYU Institutional Review Board (IRB-FY2024-8482).

At PHRC, we will continue to do all we can to help, not just in May but all year. If you have a project you need help (chronic pelvic pain or pelvic health related) with or want to suggest more avenues for us to help out please share your comments! Thank you for reading and we hope this post inspired you to help out too!

References:

Karpel, H. C., MS. (2024, May 29). Are Ob-Gyns Comfortable Discussing Sexual Trauma With Patients? Contemporary OB/GYN. Retrieved from https://www.contemporaryobgyn.net/view/are-ob-gyns-comfortable-discussing-sexual-trauma-with-patients-
Torosis, M., Carey, E., Christensen, K., Kaufman, M. R., Kenton, K., Kotarinos, R., Lai, H. H., Lee, U., Lowder, J. L., Meister, M., Spitznagle, T., Wright, K., & Ackerman, A. L. (2024). A Treatment Algorithm for High-Tone Pelvic Floor Dysfunction. Obstet Gynecol, 143(4), 595-602. https://doi.org/10.1097/AOG.0000000000005536
University of Southern California. (2024). Projects. USC Ampl. Retrieved May 29, 2024, from https://sites.usc.edu/ampl/projects/

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Are you unable to come see us in person in the Bay Area, Southern California or New England? We offer virtual physical therapy appointments too!

Virtual sessions are available with PHRC pelvic floor physical therapists via our video platform, Zoom, or via phone. For more information and to schedule, please visit our digital healthcare page.

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FAQ

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.