Written by Dr Kirk Levins, Chronic Pain Medicine Consultant
Introduction
Female pelvic pain is a complex and often debilitating condition that affects millions of women worldwide. This condition can have a profound impact on a woman’s quality of life, causing physical discomfort, emotional distress, and even disruption of daily activities. It can originate from various structures within the pelvis, including the reproductive organs, urinary system, musculoskeletal system, or gastrointestinal tract. Two common conditions causing pelvic pain are vulvodynia and endometriosis.
Vulvodynia
Vulvodynia is a chronic pain condition that primarily affects the vulva, the external genitalia of the female reproductive system. The term “vulvodynia” encompasses various types of vulvar pain disorders that share common features, including pain, burning, stinging, or discomfort in the vulvar area. This pain can be spontaneous or provoked, such as during sexual intercourse or when pressure is applied to the vulvar region. Vulvodynia can be classified into two primary categories, generalized vulvodynia and vestibulodynia (provoked vulvodynia). Generalized vulvodynia involves pain throughout the entire vulvar area. Women with generalized vulvodynia may experience constant or intermittent discomfort. Vestibulodynia is characterized by pain or discomfort primarily at the vaginal entrance or vestibule. It is often provoked by touch or pressure, such as during sexual intercourse or tampon insertion. The exact cause of vulvodynia remains elusive, and it is believed to be a multifactorial condition influenced by a combination of factors.
Management of vulvodynia can be difficult however combined conservative and interventional approaches have shown promise. Conservative management involves pelvic floor physiotherapy, oral medication such as tricyclic antidepressants, and lifestyle changes. Interventional approaches involve autonomic nerve blocks and ultrasound guided targeted injection of botulinum toxin into the pelvic floor.
Endometriosis Pain
Endometriosis is a chronic and often painful gynecological disorder that affects millions of women worldwide. It is a complex gynecological disorder characterized by the presence of endometrial-like tissue outside the uterus, often leading to chronic pelvic pain and various other symptoms. Pain in endometriosis can manifest in several forms. Two common forms are dyspareunia (painful intercourse) and pelvic girdle pain.
Dyspareunia in endometriosis is a complex and multifaceted issue that requires a comprehensive approach to diagnosis and management. Understanding the interplay between the physical, psychological, and hormonal factors involved in this symptom is essential for healthcare providers to offer effective interventions and support for women with endometriosis. Ultrasound guided injection of Botulinum toxin to the pelvic floor has shown promise in treating dyspareunia due to endometriosis.
Pelvic girdle pain (PGP) refers to discomfort and pain experienced in the area of the pelvis, specifically in the joints and ligaments that support the pelvic region. It is likely caused by a combination of factors including inflammation, high levels of estrogen causing an increase in joint laxity and pain perception, postural changes due to the pain of endometriosis and muscular. Pelvic girdle pain typically presents with pain in the buttock that is exacerbated by transitioning from sitting to standing. The pain can radiate to the level of the knee. Pelvic girdle pain often responds well to injection and lesioning of the nerves supplying the joint.
Dr Kirk Levins is a Chronic Pain Medicine consultant working across SVPH, NMH, NRH and SVUH. He has spent the last 6 years treating women with pelvic pain at both St. Vincents University Hospital and at the NMH. He is also a keen researcher and holds degrees in Chemistry and Neuroscience. He has won awards for his research including the American Academy of Pain Medicine award for research and the Abbvie scholarship. He is involved in several research collaborations with institutions in New Zealand, USA, and the Netherlands.
