Pelvis Gone Wild: A Sordid Tale of Musculoskeletal Dysfunction

Author: Meryl Alappattu

If you went to a conference of women with vulvodynia and talked to each attendee, you will likely find that each woman’s pain, how it affects her personally, physically, and sexually may be very different despite the fact that all of these women were diagnosed with vulvodynia.

Persistent or chronic, nonmalignant pelvic pain is a debilitating, costly condition described as a “clinical nightmare” by health professionals1 with primary care prevalence estimates comparable to low back pain, migraine, and asthma.2 The direct annual costs of physician visits alone related to pelvic pain are estimated exceeding $167 million dollars.3 Women with pelvic pain report sleep disturbances, depression, anxiety, and limitations in physical mobility.4,5 Like other pain conditions, pelvic pain is not homogenous. If you went to a conference of women with vulvodynia and talked to each attendee, you will likely find that each woman’s pain, how it affects her personally, physically, and sexually may be very different despite the fact that all of these women were diagnosed with “vulvodynia.” Many report a variety of symptoms, including the presence of pelvic pain with dyspareunia (pain with sexual intercourse) or pelvic pain with dysmenorrhea (pain with menstruation), for example, rather than a single issue of dysmenorrhea or dyspareunia alone. Physical therapists have long been recognized for their role in the management of other musculoskeletal pain conditions, including spinal and extremity pain. Over the last several decades, a specialty practice of physical therapists includes those who work closely with physicians, psychologists, nurses, and counselors to manage musculoskeletal aspects of pelvic pain. The information in this article provides both referring providers and patients with an idea of what to expect as part of the initial examination and subsequent treatment interventions performed by a physical therapist.

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