Female Pelvic Pain

It is estimated that 20% of women experience pelvic pain at some point in their lives. Numerous studies have shown that the musculoskeletal system is often a primary or secondary cause of pelvic pain in women; therefore, physical and occupational therapy plays a major role in the diagnosis and treatment of female pelvic pain.

Common Symptoms of pelvic pain often include one or a combination of the following:

• provoked or unprovoked vulvar, vaginal, clitoral, perineal or anal pain
• dyspareunia
• pain following sex
• interlabial, vulvar or genital itching
• painful urination, urinary hesitancy, urgency, and/or frequency
• abdominal and groin pain
• sacroiliac joint pain/instability
• constipation
• painful periods
• difficulty wearing jeans, pants, or underwear
• pain with sitting
• difficulty exercising

Associated Diagnoses

Oftentimes, our female patients are misdiagnosed as having a yeast or urinary tract infection. If the cultures are negative this is not likely the case, though recurrent infections can be a contributing factor to pelvic pain. Other associated diagnoses include:

• Interstitial Cystitis/Painful Bladder Syndrome
• Vulvodynia/Vestibulitis
• Clitorodynia
• Persistent Genital Arousal Disorder (PGAD)
• Pudendal Neuralgia
• Endometriosis
• Irritable Bowel Syndrome
• Tailbone pain/coccydynia
• Proctalgia Fugax
• Pelvic Girdle Pain
• Sacroiliac Joint Dysfunction

“Seriously, your office is amazing. Melinda is a wonderful PT and Fiona does a great job of communicating. I am thrilled with everything you do and only wish I found you sooner!”

Evaluation and Treatment

During a  patient’s first appointment at PHRC a.k.a. the “evaluation appointment,” a physical and occupational therapists will take an extensive medical history. Following the history, the physical and occupational therapists will perform a thorough external and internal musculoskeletal examination. You are always welcome to have another individual in the room during evaluation and/or treatment.

Your initial evaluation may include:

• Postural and structural assessment
• Evaluation of connective tissue in the abdomen, back, pelvis and lower extremities
• Myofascial evaluation of the pelvic girdle muscles
• Examination to identify myofascial trigger points in the pelvic girdle and pelvic floor muscles
• Pelvic floor examination (done by gently inserting a gloved, lubricated, finger into the anus) to assess muscle tone, motor control, strength, nerve and coccyx tenderness
• Evaluation of muscle strength
• Skin inspection
• Peripheral altered neurodynamics testing/palpation

Following the physical examination, your physical and occupational therapists will discuss your physical findings, their assessment, and your prescribed treatment plan. This will include the suggested frequency and duration of physical and occupational therapy. For local patients,  physical and occupational therapy treatments are weekly and one-hour in length. Usually a patient will undergo eight weekly sessions, at which time we will perform a re-evaluation and set new goals based on progress. A patient with pelvic pain is typically seen at least 12 times; however, the duration may vary based on the severity and chronicity of the problem.

The treatment you will receive at PHRC will be 100% one-on-one physical and occupational therapy. You will never be left alone in a room hooked to a machine, or left in the care of a PT’s assistant.

In addition, at PHRC we embrace a multidisciplinary treatment approach, meaning that our therapists draw from all appropriate medical disciplines to develop a comprehensive treatment plan for our patients. Toward that end, we have established a wide network of pelvic floor specialists throughout the country that we regularly draw from to round out our patients’ healing. Once your team of providers is in place, we embrace the role of team leader. In that role, we communicate and coordinate with all other providers as well as recommend any adjunct treatments that we believe can play a role in your healing.

“Melinda was flat-out awesome. She has a very warm and disarming personality that always made me feel comfortable. On top of that, she is extremely well trained and proficient at pelvic floor rehab, and did a good job adapting to my needs.”

Another important tenet of our care is patient communication. Prior to your first appointment and throughout the treatment process, you will have access to your PT to ask questions or discuss concerns. It is our commitment that in every area of treatment, we will take that extra step (or leap!) to ensure that you receive the best treatment possible to meet your goals.