Because many women avoid talking about this with their friends, family members and even their sexual partners, pelvic pain can be emotionally exhausting as well as physically unbearable.
Vulvodynia: An excruciating affliction of the vulva which affects an estimated 16 percent of women at some point in their lives, vulvodynia is described in this video from the Dr. Oz show as feeling like "acid burning the skin" or a "constant, knife-like pain." It can be caused by trauma to the pelvis, which may result from chronic yeast or bacterial infections, physical force, accidents, surgery, or physical or sexual abuse.
I know a woman in her mid-20s who has suffered from vulvodynia since childhood. She suspects the cause may have had something to do with an ill-fitting waist harness on a forceful carnival ride. In her quest for relief, she was referred to gynecologists, dermatologists and psychologists, and tried topical anesthesia, antidepressants, talk therapy and the patronizing advice to "have a glass of wine and you'll be fine." She was finally told that pain-free sex would require surgery, and her doctor advised her to visit a women's health physical therapist to prepare for the procedure.
"Many doctors assume that women's health physical therapy can only take you to a certain point," says my friend's therapist, Gopi Jhaveri, PT, DPT, co-owner of Brooklyn Health Physical Therapy, "but we know it can take you all the way to recovery." Jhaveri discouraged the surgery and instead worked with my friend to develop a rehab program. Four months later, my friend joyfully credits Jhaveri with her "cure."
The regimen: This varies depending on the patient's anatomy and type and severity of symptoms, but treatment often includes regular in-office manual therapy, at-home stretching using dilators, exercising daily to strengthen the pelvic muscles, avoiding harsh cleansers like soap in favor of sweet almond oil, and using a local anesthetic like lidocaine during sex.
Vaginismus: A 2010 episode of MTV's True Life featured three women in their 20s whose pelvic conditions prevented them from having intercourse. Tali, an aspiring singer, had a condition called vaginismus, which involves painful, involuntary spasms and tightening of the vagina. As part of Tali's treatment, Isa Herrera, MSPT, clinical director of Renew Physical Therapy in Manhattan, showed Tali and her boyfriend how to manually stretch Tali's vagina (it was more clinical than kinky).
Herrera specializes in intra-vaginal massages to release tight or uncooperative muscles, and also in teaching patients and their partners to do this as home. "One out of three women has some sort of pelvic pain," says Herrera, who is also the author of Ending Female Pain: A Woman's Manual. However, she says, many women don't admit it. "I've heard excuses like 'it hurts unless I keep changing positions' or 'it hurts because my partner is so big.' But the vagina is a wonderful thing and should be able to accommodate just about any man." Herrera says WHPTs empower women to recognize and alleviate their physical discomfort.
The regimen: Techniques vary, but Herrera says she often follows a full pelvic muscle evaluation with manual massage, including trigger-point release technique to "release knots." Herrera stressed that although the pain may occur in the pelvic area, the most successful approaches are holistic and involve the entire body. "Pain during sex can cause enormous anxiety, which results in the tensing up of different muscles groups, from the pelvis and the legs to the neck and back." An important aspect of treatment includes diaphragmatic breathing and relaxation techniques to help the patient deal with the anxiety as well as the pain.
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