This week on BackTable Urology, Dr. Suzette Sutherland (University of Washington) and Dr. Priyanka Gupta (University of Michigan) discuss the multifactorial components that can contribute to pelvic pain and how urologists can approach treatment for this condition.

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SHOW NOTES

Pelvic pain can originate from bladder-centric symptoms, pelvic floor dysfunction, GI-centric symptoms, gynecologic symptoms, musculoskeletal and psychosocial issues, and systemic problems. First, the doctors summarize how to perform a thorough pelvic physical exam. They explain how to identify the obturator muscles and levator complex with a digital exam. They differentiate between bladder-centric pain and pelvic floor-centric pain and emphasize not beginning with a speculum exam, which can cause pain in some patients. They also suggest using a speculum to check for masses or lesions and prescribing vaginal estrogen supplementation.

Then, Suzette and Priyanka examine the role of pelvic floor physical therapy in treating pelvic pain and how to communicate with patients about what to anticipate in physical therapy. In addition, Priyanka explains the approach to transvaginal injections for pelvic floor dysfunction, including the injection of a mix of long-acting anesthetics at 1, 3, 5, 7, 9, and 11 o'clock behind the pubic bone and deeper at the level of the ischial spine. Finally, she discusses the role of insurance coverage for these injections.