Interstitial cystitis is a bladder condition that usually consists of multiple symptoms. Most IC patients have recurring pelvic pain, pressure, or discomfort in the bladder and pelvic region. Common complaints are burning, urinary frequency (needing to go often) and urgency (feeling a strong need to go). Both men and women can suffer from this condition, oftentimes having their symptoms mistaken for Urinary Tract Infections, as the symptoms can be similar. The medical knowledge surrounding IC, also known as painful bladder syndrome, is expanding and the diagnosis and treatment of this condition is evolving. It is commonly a cause of chronic pelvic pain. There are treatments available which can improve the quality of life for those who suffer from this condition.
Pelvic Floor Dysfunction
Tension in the pelvic floor is a common cause of pelvic pain that is not widely recognized. Unlike in pelvic floor disorders caused by relaxed muscles such as pelvic organ prolapse or urinary incontinence, both of which often are identified easily, women affected by non-relaxing pelvic floor dysfunction may complain of a wide range of nonspecific symptoms. These may include pain and problems with having a bowel movement, urgency or frequency of urination, difficulty with pelvic examinations, pain with use of tampons and painful intercourse. These symptoms may adversely affect quality of life.
There are many reasons that tension in the pelvic floor may develop. It is important to be evaluated by a knowledgable Gynecologist who can help you determine if your pelvic muscles are involved and rule out other serious conditions that may need further evaluation. Pelvic Floor Physical therapy can help women and men fully recover and prevent flares of this debilitating pain in the future.
Vaginismus occurs when the muscles of the pelvic floor are so tight or hypertonic so as not to allow anything to enter into the vagina. Vaginismus is listed as a “genito-pelvic pain/penetration disorder” in the Diagnostic and Statistical Manual of Mental Disorders (DSM 5), it is both an emotional and pain disorder. The true incidence of vaginismus is unknown as women frequently do not discuss their symptoms. Observational studies of women evaluated in sexual health clinics have reported a prevalence of 5 to 42 percent.
Vaginismus has traditionally referred to involuntary contraction of the muscles of the pelvic floor surrounding the vaginal orifice. The patient is averse to vaginal penetration (sexual and nonsexual, such as gynecological examination, tampon, dilators) due to actual or anticipated pain. Subcategories of vaginismus to describe patient variations have been proposed, including:
●Primary vaginismus: lifelong pain with attempted vaginal penetration
●Secondary vaginismus: progression to painful vaginal penetration after some pain-free period
●Situational vaginismus: inability to tolerate certain forms of penetration such as intercourse, yet insertion of tampons or fingers is possible
●Spasmodic vaginismus: spasm of the vagina
●Complete vaginismus: inability to tolerate any vaginal penetration
Dyspareunia (Painful Sex)
Dyspareunia is a painful condition that occurs with sex. It can be superficial or deep. It can occur during or after intercourse. There are many conditions that can contribute to painful sex including interstitial cystitis, pelvic floor dysfunction, constipation, chronic vulvovaginitis, vulvodynia, genital autoimmune conditions such as lichen sclerosis and commonly menopausal dryness from a decrease in estrogen after menopause. A past history of sexual abuse can impact a person’s ability to enjoy sex and can manifest itself as pain. Women and men who suffer from chronic pelvic pain oftentimes have this as one of the presenting features. Many treatments are available to address the conditions listed.
Vulvodynia or Vestibulitis:
Vulvodynia is a chronic vulvar pain without an identifiable cause. There can be variation in the location and severity amongst individuals. Some women experience pain in only one area of the vulva, while others experience pain in multiple areas. The most commonly reported symptom is burning but it often is described as knife like sensations. Pelvic floor dysfunction can oftentimes contribute to vulvodynia.