“According to the World Health Organisation, pelvic pain in women is incredibly common. It’s not a minor inconvenience. Pelvic pain can interfere with daily activities such as work and exercise, but it can also be a sign that something is wrong” [1]
Women’s pelvic pain is a highly complex subject, and not something which should by self-diagnosed. Indeed, the AMITA Health Women’s Health Institute recommends that individuals who are feeling any kind of pelvic pain [1], (for example: pain in lower female abdomen or pelvis; pain in the centre of the pelvis; severe abdominal pain; slight pressure or pain in the pelvis; a dull ache in the abdomen; persistent pressure in the pelvis; pelvic inflammatory disease, also known as PID; or a sharp stabbing pain), should arrange a consultation with a specialist as soon as possible.
Chronic Pelvic Pain in Women
Long-term/chronic pelvic pain refers to experiencing continual or intermittent pain in the lower abdomen or pelvis for more than six months (providing it does not occur solely during intercourse or menstruation). Alarmingly, sufferers who report: “a lower quality of life, with high rates of functional impairment, psychosocial distress and sexual dysfunction, risk being labelled as difficult or needy, and may struggle to be believed when accessing healthcare services” [2], so to that end, discussing your own personal circumstances with a specialist who has many years of experience and understanding in the field, is essential.
What Women Want
Of note, research has pinpointed four key themes which are important for women suffering from long term pelvic pain. They want:
• To be given individual pelvic pain care by an understanding and supportive health care team
• To be respected as someone who is experiencing genuine pain
• To be given an assurance that their pain is not related to cancer; and that their form of pelvic pain is experienced by other women; and that their suffering can be treated.
• To be clearly told why they have their condition, regardless of whether or not a pathology has been identified [2].
The London Pain Clinic specialists take a multi-disciplinary approach to diagnosis, investigation and management. They explain everything to patients in laymen’s terms; and always consider the fact that there could be numerous root causes behind the pain and subsequent sequelae (the after effect of a condition, disease, or injury), which include behavioural, sexual, low mood and emotional consequences. [2]
“The most important thing for women with chronic pain is for their pain to be validated. In the absence of an identifiable cause, it is essential to educate women that there is no one ‘magic bullet’ that will resolve their pain. It is a journey that both doctor & patient will go on, with the hope of finding strategies to help cope with & minimise the pain over time [2]
How is My Pelvic Pain Assessed?
Firstly, after an in depth discussion, and gaining an insight into your own personal issues with with pelvic pain and how it impacts your life, your women’s pelvic pain specialist will take your full medical history. This will entail looking at the distinguishing features of the pain, as well as any co-morbidities and contributing factors. He/she will conduct a pelvic and abdominal examination (which will include evaluating your pelvic floor muscles); as well as an assessment of any musculoskeletal abnormalities. Further, in order to rule out any infections, various laboratory tests may be carried out. Moreover, in the case of some patients, referral for a laparoscopy or ultrasound may be appropriate [2].
What Sort of Questions Will I be Asked?
Many areas will be covered. These will include:
• As many details as possible about your pain, and what you think could be the cause
• Your general level of functioning (whether you feel tired during the day, etc.)
• Whether you have any co-morbidities (more than one illness or disease occurring in at the same time)
• The functioning of your menstrual cycle
• How your bowel and bladder are working
• Your sexual functioning (if you have any history of abuse, you should inform the consultant)
• Details of any medication you are taking, and whether it is effective [2].
Questions Which Will Put a Spotlight on Your Pain
• Site/s: If you are feeling pain in more then one area, which one is the worse?
• Onset: How long have you been experiencing this pain? When did it first appear? Was the start of it linked to a preceding event such as surgery or giving birth?
• What sort of character does the pain invoke? – Nerve entrapment or damage normally generates electric shock-like, hot, or burning pain. Whereas visceral pain can be described as diffuse and dull, in an area which is hard to precisely locate.
• Radiation: Pain from the fallopian tubes or ovaries or can radiate into the midline of the thigh. While pain emanating from the uterus, vagina or cervix, frequently radiates to the buttocks or lower back.
• Associations: Do you have any signs or symptoms that are linked with your pelvic pain? Examples include: defecation, urination, intercourse and menstruation, and is there a cyclical pattern?
• Relieving and exacerbating factors: These include stress, anxiety, depression, poor sleep, and life events which could worsen the pain. And any pharmaceuticals or natural remedies which may ameliorate it.
• Severity: Long term pelvic pain fluctuates over time, so if you put together a pain diary with daily or weekly notes, prior to your consultation, it could be very beneficial [2].
If this is something think you may suffer from, or would like help with – You can make an appointment with one of our specialist Doctors via The London Vulva Pain Clinic
What Happens if a Specific Cause is Not Found?
If your assessments, examinations and tests, do not highlight a specific cause for your pelvic pain, then various medications could be used to manage of your condition. These include analgesia and adjuvant medicines. Moreover, you will be given various potentially successful pain modulation strategies involving sleep, diet and exercise. “The overall aim is to provide the woman with support to self-manage and be able to cope with her pain” [2].
References
[1]. Merchant, S. (2019). “What Is Your Pelvic Pain Trying to Tell You?” AMITA Health.
https://www.amitahealth.org/blog-articles/womens-health/what-is-your-pelvic-pain-trying-to-tell-you
[2]. bpac. “Chronic Pain in Women.” Best Practice Journal 2015. BPJ: 70
https://bpac.org.nz/bpj/2015/september/pelvic.aspx
