Painful Gynecology Exams- is it all in your head or is it chronic pelvic pain? What to do about it?
Updated: Apr 17
Things I hear from patients about how they are dismissed when they have painful gyn Exams: "Its in your head, its suppose to be painful, you have a small v@gina, you are too soft, don't be a baby" Yup you heard it right, these are the actual things my patients have heard from their providers when they complaint of pain with pelvic exams!
Pelvic Pain with any type of penetration including gyn / pelvic exams is VERY real! Dismissing patients concerns and complaints about pain as insignificant or non existant or psychological is a type of medical gaslighting, and can often leave patients in trauma from the exams, sometimes lifelong trauma. It can also push them further in anxiety and more pelvic pain. So if you feel that you are not heard, please change providers!
For many women, this position with feet up stirrup can cause
anxiety, they feel less in control and can be overwhelming.
The provider can be asked to accommodate patients to make
them comfortable, not rush the exam, and seek permission or tell
the patient step by step what would be done during the session.
Let's look at some of the common
reasons why you might have pelvic pain with gyn/ pelvic exams.
Vaginismus: It is described as recurrent or persistent involuntary tightening of muscles around the vagina whenever penetration is attempted. It can have physical or non physical causes or no particular cause.
The symptoms include burning or stinging pain upon penetration, as well as intense fear, anxiety or loss of desire when penetration is attempted. It can lead to decreased self worth, self blame and feeling of guilt. Please know that is it NOT your fault, not your body's fault.
Many providers hand out dilators which a leaflet with instruction on using it. This pushes many patients further in to anxiety cycle, because vaginismus is not just about penetration. Treatment should factor in the stress factors, psychological factors, physical factors, emotional, social factors contributing to the symptoms. Most of the vaginismus patients that we see in the clinic, the first few sessions are spend getting comfortable with the idea of the treatment, the goals, the feeling of safety. We seek permission of the patients before any treatment is initiated every session, the patient knows exactly how the treatment plan will go for that particular session.
Generalized Vulvodynia pain map is shown in the right hand side picture and Provoked Vestibulodynia is on the left hand side.
Prevalence of Vulvodynia is as high as 28%. Many vulva owners are diagnosed after a few rounds of multiple specialists, many are dismissed as having pelvic pain and either given pain meds or estrogen creams. Please note, not all vulvodynia type can be helped by hormones, although can do.
Provoked vestibulodynia (PVD) refers to vulvar pain of at least 3 months duration, localized to the vestibule, provoked by touch and sexual activity and occurring in the absence of a clear identifiable cause.
Resouces that can be helpful:
NVA - National Vulvodynia Association
Beyond Pelvic Pain
Irwin Goldstein’s books
When Sex Hurts: A Woman's Guide to Banishing Sexual Pain
Internation Pelvic Pain Society
Female Sexual Pain Disorders
Chronic Pelvic Pain
The prevalence of chronic pelvic pain is approximately between four to sixteen percent of women. Only a third of women suffering from chronic pelvic pain seek medical care.
Chronic pelvic pain in women is often defined as persistent, noncyclic pain, but can also be cyclical. The patient's pain is located within the pelvis and has lasted greater than six months duration.
How can Pelvic PT help with above?
Studies have shown 70% success rate of moderate or great improvement in vulvar pain, as well as decreased pain with intercourse and gynecological exam, and increased intercourse frequency, desire, and arousal
It is important to find a Pelvic PT who has worked with vulvodynia patients, because treatment is much more or rather different than just pelvic muscle stretching and biofeedback. It should involve,
⚡️Education about your anatomy and understanding of symptoms and treatment plan. ⚡️Pain science education so that you can integrate that in to self care.
⚡️Learning about triggers for pain whether emotional, mental or physical
⚡️Internal and external manual therapy
⚡️Visceral techniques if needed.
⚡️Other techniques for working around the pelvic
⚡️A good functional home program to follow up after session
How can I find a good pelvic floor PT?