CHRONIC PELVIC PAIN is pain that is felt in the abdomen, hips, pelvis, perineum, genitals, thighs, buttocks and rectum, that has persisted for six months or longer . Chronic pelvic pain syndromes can range from mild to severe. Pain can interfere with work, sexual relationships, sleep and activities of daily living. Generalized Chronic Pelvic Pain may be seen in combination with vulvodynia, vulvar vestibulitis, vaginismus, sexual abuse, endometriosis, cystitis syndromes, interstitial cystitis, pelvic muscle tension syndromes, fibromyalgia, chronic fatigue syndromes, irritable bowel syndrome, traumatic injury, vaginal, testicular, penile, and groin pain. Pelvic pain can be difficult to diagnose correctly. Often there is no known cause. Patients may see several doctors, have various treatments subscribed, with the outcome being incomplete relief. The physical examination may find no abnormalities, however, that does not mean that there is nothing physically wrong. It is important to know that the persistent pain is not your imagination, but is very real. Chronic Vulvar Pain Syndromes Vulvodynia is defined as chronic vulvar pain such as itching, burning, stinging, throbbing irritation of the female genitalia. There are two types: one is organic, which has a known cause and the other is dyesthetic or essential, which has an unknown cause. Pain can be constant or intermittent, localized or more widespread. Sleep may be disturbed. Depression may accompany this condition. Sexual intimacy and intercourse are often painful (dyspareunia) or impossible, due to vaginismus which is an involuntary contraction of the vaginal muscles. Bladder and bowel symptoms may occur. Walking, sitting and wearing tight clothing can be painful. Vulvar vestibulitis: Pain is felt in the vestibule, the area surrounding and including the vaginal opening, particularly when the area is touched. Burning, stinging, itching, pressure, rawness or the feeling of being swollen around the vestibule area are common symptoms. Clitoral pain or sharp stabbing pains can be present. There may be some redness of the vestibule. Painful sex, with or without vaginismus may occur. Women may also have some bladder symptoms (urgency and frequency) and pain around the urethral opening, urethra and anal region. Interstitial cystitis, a bladder condition, may be involved with this condition. Bowel problems may exist. Attempts at intercourse or insertion of a tampon are often painful or even impossible. Some women only experience pain during vaginal penetration, but others also have pain when exercising, sitting, bicycling and when wearing pantyhose or tight slacks. Common Diagnoses of Chronic Pelvic Pain Pelvic Floor Tension Myalgia and Levator Ani Syndrome: Pain is produced in the back, vaginal, anorectal, lower abdominal, coccygeal, thigh & pubic regions. Dyspareunia: Pain occurs during vaginal penetration/intercourse in the vagina. Vaginismus: Vaginal muscles contract involuntarily when vaginal penetration is attempted, causing vaginal pain. Anismus: Pain is felt in the anorectal area. Constipation often results. Proctalgia Fugax: It produces rectal pain, often intense, of short duration or a strong dull ache of a longer duration. It can awaken you during sleep. Coccygodynia: It produces coccygeal (tailbone) and rectal pain. Chronic prostatitis: It produces urethral, bladder, testicular, penile, anal, & groin pain. Pudendal Neuralgia: It produces localized burning in perineal area, can be one sided. Endometriosis Endometriosis is a condition in which the tissue lining the inside of the uterus is found in areas outside of the uterus. This tissue migrates to areas in the abdomen, vagina, cervix, vulva, outer uterine surface, pelvic cavity lining, intestines, rectum and bladder. The endometrial tissue builds up, breaks down causing bleeding each month in the menstrual cycle. This can cause pelvic, bladder, bowel pain and painful intercourse. Chronic pelvic pain can be due to an imbalance of musculoskeletal and neuromuscular functions of the body, sexual abuse, direct trauma, childbirth, infections, surgery, and various medical conditions. A source of pain can cause increased pelvic muscle spasm which creates more pain resulting in a vicious pain/spasm cycle. Accompanying this cycle, often there is a change in the way pain messages travel and are interpreted from the pelvic region to the brain and back to the pelvic region. The pain felt from a normal touch can be intensified or abnormal i.e. burning, stinging and itching. Physiotherapy treatment can help to relax the pelvic muscles and to release trigger points often found in these muscles, resulting in a decrease in pain. Desensitization of the tissues assists in returning the neuromuscular pain mechanisms to normal. As your pain subsides and the pelvic muscles are able to relax, comfortable sexual intimacy becomes possible! Other components of the treatment program may include: biofeedback, pelvic & other musculoskeletal rehabilitation, pain reducing techniques, postural correction, internal vaginal or rectal therapy techniques, electrical stimulation, bladder &/or bowel management, relaxation training, dietary management and diary assessment.