Let's Talk Chronic Pelvic Pain

Summary:

In this episode, we sit down with Dr. Lara Harvey to discuss pelvic floor dysfunction—what it is, how it’s diagnosed, and the full spectrum of treatment options available. We review the basics of pelvic floor anatomy and walk through what to expect during a pelvic exam, including how clinicians assess muscle tension, coordination, and pain. Dr. Harvey then breaks down evidence-based treatments, from pelvic floor physical therapy to medications and procedural interventions like trigger point injections and pudendal nerve blocks.

Outline:

• Review of pelvic floor anatomy and function and what to expect with the pelvic floor exam
• The role of pelvic floor physical therapy, expectations and recommendations
• Other treatments for pelvic floor dysfunction include a variety of medications and procedures
• Medications:
  • Vaginal medications
  • NSAIDs
  • Muscle relaxants
  • Neuromodulators
• Procedures:
  • Bilateral pudendal nerve blocks
  • Pelvic floor trigger point injections with Botox or steroids and considerations for each of these medications
  • Goal of the injections is generally a more temporary pain relief, can assist with progressing with pelvic floor PT
• Resources:
  • American Physical Therapy Association, International Pelvic Pain Society (IPPS) patient resources, https://www.voicesforpfd.org/ by AUGS

In this episode of "Let's Talk Chronic Pelvic Pain," Dr. Annie Apple interviews expert Dr. Melinda New to shed light on two causes of pelvic pain: vaginismus and vulvodynia. If you're dealing with pelvic discomfort related to these conditions or just want to deepen your understanding, this episode provides valuable insights into diagnosis and treatment options.

Outline:

• Overview of vaginismus: involuntary muscle tightening of the vaginal muscles, often triggered by emotional or physical factors.
• Explanation of vulvodynia: superficial pain on the vulva with both provoked and unprovoked categories.
• Differentiating muscular versus superficial pain: key features and symptoms, including sensations like burning or sharp pain.
• Importance of detailed history-taking: trauma, injury, infections, or dermatologic conditions.
• Physical exam components: cotton swab (Q-tip) testing, pelvic floor assessment, and identifying specific pain hotspots.
• Diagnostic challenges: lack of validated tests and reliance on ruling out other causes.
• Treatment options including medications like neuromodulators, topical lidocaine, and therapies like pelvic floor PT and sex therapy.
• The role and considerations of surgical intervention, specifically vestibulectomy, as a last resort.
• Use of trigger point injections for temporary relief, especially in cases of localized pain.
• Resources for patients: National Vulvodynia Association and Tight Lipped Foundation, emphasizing reputable information sources.

Summary:

In this episode of Let’s Talk Chronic Pelvic Pain, we’re joined by Dr. Ryan McGowan, Assistant Professor of Clinical Anesthesiology and Pain Medicine, to explore the complex world of chronic pain and central sensitization. Together, we break down how pain is processed in the body, why it can persist even after an injury heals, and what treatment options are available including medications, acupuncture, nerve blocks, and even spinal cord stimulation.

Outline:

• How do we measure pain
• What is central sensitization
• Common triggers for central sensitization including endometriosis, IC, vulvodynia, childbirth
• Signs of central sensitization such as an amplified pain response to something that was not previously painful
• What are treatment options that interventional pain can offer?
  • Medications (multimodal approach, the role for opioids and non opioid pain medicines)
  • Topicals (lidocaine patches, TENS units)
  • Nerve blocks
  • Acupuncture
  • Cryoablation/Radiofrequency ablation
  • Nerve stimulators
• Reframing goals of treatment - not "pain free" but improved quality of life
• Importance of finding a specialist team with experience in chronic pain and validation of pain experiences

Summary:

Dr. Annie Apple and Pam Waynick-Rogers DNP WHNP discuss how trauma-informed care can transform the approach healthcare providers take, especially during sensitive procedures like pelvic exams. This episode explores patient autonomy, the impact of trauma, and how to advocate for a safe, supportive environment for patients with pelvic pain or trauma histories.

Outline:

• What is trauma-informed care and why is it critical in women's health?
• How trauma impacts pelvic pain and patient responses during exams
• Recognizing signs of trauma-related anxiety, dissociation, and guarding
• Techniques to create a safe, empowering clinical environment
• Practical ways to communicate with patients about procedures and trauma triggers
• The importance of consistent screening for trauma and mental health history
• How to address social media influences and patient expectations
• Resources and tools for implementing trauma-informed practices
• The clinician's role in reducing re-traumatization during pelvic exams and other procedures
• The evolving healthcare model focused on patient partnership and shared decision-making

Summary:

In this episode, Dr. Annie Apple and Dr. Michelle Weyhaupt, a psychiatrist and specialist in women's mental health, delve into the significant connection between mental health and chronic pelvic pain, aiming to destigmatize these conditions and affirm their validity. We explore the physiological and psychological aspects, offering insights into comprehensive treatment approaches.

Outline:

• There is a significant association between chronic pelvic pain and mood disorders like anxiety and depression.
• Reviewing the mind-body connection: stress response, inflammation, and central sensitization.
• Recognizing symptoms of depression and anxiety in the context of chronic pain.
• The importance of treating both physical pain and psychological conditions through a multidisciplinary approach.
• Understanding treatment options including medications and therapy
• Tips for improving your relationship with your body

Summary:

Curious about pelvic floor physical therapy and how it can transform your health? In this episode, we dive into what pelvic floor PT is, who can benefit, and how the assessment and treatment process work, exploring a specialized and often misunderstood field.

Outline:

• What is pelvic floor physical therapy and which conditions does it treat?
• Differences between hypertonic (high tone) and hypotonic (low tone) pelvic muscles
• The comprehensive assessment process: external, internal, and rectal evaluations
• Common misconceptions: it’s not just for postpartum women or Kegel exercises
• How pelvic floor PT can improve pain, urinary, bowel, sexual function, and overall well-being
• The importance of tailored treatment plans and patient education
• Use of tools like vaginal dilators and pelvic wands for self-management
• Addressing stigma and taboo around pelvic health and advocating for women’s health education
• The significance of early education on menopause and aging

Summary:

In this episode of Let's Talk Chronic Pelvic Pain, Dr. Annie Apple interviews clinical psychologist Dr. Susanna Sutherland, PhD to explore how mental health and coping skills play a crucial role in managing chronic pelvic pain. They discuss practical strategies for developing positive coping mechanisms, addressing emotional challenges like grief and loss, and navigating therapy options—especially cognitive behavioral therapy (CBT)—for better quality of life despite ongoing pain.

Outline:

• The broad impact of chronic pelvic pain on mood, relationships, and identity
• What coping is: managing stressors through behavioral and mental processes
• Differentiating controllable vs. uncontrollable stressors
• How avoidance behaviors can negatively affect mental health and quality of life
• Developing positive coping strategies: practical examples such as symptom control, communication, and planning
• Addressing emotional grief and adjusting to a new normal through CBT techniques
• The fundamentals of cognitive behavioral therapy: thoughts, feelings, and behaviors
• Common misconceptions about therapy and how to find the right mental health support
• The role of support groups and community resources for ongoing emotional support
• How social media and online communities can both help and hinder mental health
• The importance of multidisciplinary care and available resources like the Osher Center

Summary:

This episode explores the impact of pelvic pain on sexual function, emotional well-being, and relationships. It covers common sexual health disorders related to pelvic pain, such as hypoactive desire and pain with penetration, and discusses the emotional challenges like shame and anxiety that can arise. The episode highlights treatment options, including medications, pelvic floor physical therapy, and sex therapy, and offers practical tips for improving intimacy and communication with partners. It emphasizes the importance of social support and planning for recovery, as well as navigating the costs of therapy.

Outline:

• Definitions of sexual health, dysfunction, and their psychosocial components.
• Common sexual health disorders related to pelvic pain: hypoactive desire, pain with penetration, orgasmic disorders.
• The impact of pelvic pain on self-identity, self-esteem, and intimate relationships.
• How sexual dysfunction can lead to emotional challenges like shame, guilt, anxiety, and depression.
• Navigating partner expectations and communication when experiencing pelvic pain.
• Treatment options including medications, pelvic floor physical therapy, lubricants, and surgical interventions.
• The benefits and process of sex therapy, including what to expect and its accessibility.
• How medications for depression or anxiety may affect sexual desire, and strategies for management.
• Practical tips for starting sex therapy, setting goals, and improving intimacy.
• Importance of social support and planning recovery/post-treatment activity levels.
• Insurance considerations and navigating costs for sex therapy.

Summary:

This episode of Let's Talk Chronic Pelvic Pain delves into adenomyosis and uterine fibroids, two significant causes of chronic pelvic pain. Dr. Howard Curlin explains the anatomy of the uterus, the symptoms associated with adenomyosis and fibroids, and the challenges in diagnosis. The conversation also covers various treatment options, including medications and surgical procedures, while emphasizing the importance of individualized care based on patient goals and symptoms.

Outline:

• Adenomyosis involves the endometrial glands growing into the uterine muscle.
• Common symptoms of adenomyosis include heavy and painful periods.
• Fibroids are smooth muscle tumors that can vary in size and location.
• Many women will have fibroids, but not all will experience symptoms.
• Small fibroids are often incidental findings and not the cause of pain.
• Adenomyosis is frequently the underlying cause of pelvic pain.
• Treatment options include hormonal medications and surgical procedures.
• Hysterectomy removes the uterus but does not always involve the ovaries.
• Uterine artery embolization may pose risks for future pregnancies.
• Surgical management of fibroids include hysteroscopic myomectomy, laparoscopic myomectomy or abdominal myomectomy.

Summary:

The episode provides an in-depth look at endometriosis treatment, focusing on surgical options such as diagnostic laparoscopy, excision, and ablation techniques. It discusses the factors influencing surgical planning, including disease severity and location, and the choice between conservative and definitive surgery. The episode also covers the importance of preoperative health optimization, potential risks, and postoperative expectations. Additionally, it highlights the significance of consulting specialists for personalized care and the role of medications in reducing recurrence.

Outline:

• The role and procedure of diagnostic laparoscopy for endometriosis.
• Differences between excision and ablation techniques, and when each is appropriate.
  • How severity and location of disease influence surgical planning.
  • The importance of seeking a specialist with extensive experience for complex cases.
• The recurrence rates of endometriosis post-surgery and factors affecting long-term success.
• Timing surgery in relation to fertility goals and comprehensive treatment planning.
• When and why to consider repeat surgeries for recurrent disease.
• The role of medications and medical therapy after surgery to reduce recurrence.
• Considerations for conservative vs. definitive surgery, including hysterectomy and ovarian removal.
• Risks associated with endometriosis surgery:
  • Complications, bleeding, damage to surrounding structures, need for additional procedures
• Preoperative health optimization:
  • Managing other conditions such as anemia, diabetes, and other chronic health problems.
• Postoperative expectations:
  • Recovery timeline, activity restrictions, and social support.
• Making a decision about the right time for surgery, lifestyle factors and goals of treatment to consider
• Importance of reframing to think about long-term management tailored to your symptoms, goals, and overall health