May is National Pelvic Pain Month from which an estimated 15% of men and women suffer. I had the pleasure of interviewing Dr. Alicia Bolden-Jeffers, a fellow physical therapist who not only has treated women and men for pelvic pain but is also a survivor of pelvic pain.
Pelvic pain in general terms would be any pain “down there” in the groin, taint, anus, and tailbone. This can lead to sexual dysfunction ranging from erectile dysfunction in men to painful penetration in men and women, pain when riding a bike, sitting in the car, or even having a bowel movement.
Alicia was 19 when she went to her ob-gyn for her first pap smear. The pain she experienced at that time was over after the test was done and was written off as normal when getting a first pap smear. But during the test, she says, it felt like someone had a lit match to her vagina. The following year, she went in for another pap smear, but things were worse due to the fear and anxiety of the anticipated pain, and this time she had increased blood pressure and sweats. She also began to have pain with intercourse. This added even more stress and anxiety between her and her boyfriend. She wanted to be sexual but just couldn’t tolerate the pain. Fortunately, her doctor recommended pelvic physical therapy. She went to the only person in town fitting that bill, who was also a colleague. It was thought at that time that the pain was due to stress and anxiety. The result was that she was referred to counseling. While stress and anxiety can exacerbate pelvic pain it is now better understood that there is often a physical reason for the pain. Alicia moved to Baltimore which meant seeing a different pelvic therapist that lead to a different perspective. There was a narrowing of the vaginal vault (also known as vaginismus) but she also had vestibulitis: extra nerve tissue at the vaginal opening which made it hypersensitive. She did well with dilators to stretch and open up the vaginal vault which led to easier intercourse (yeah!). She also did several rounds of Botox in order to quiet the nerves. There was also a lot of manual therapy, in which the therapist released trigger points in the pelvic floor muscles, stretched the fascia (elastic connective tissue that helps hold us together), and gave Alicia exercises to take control and use her pelvic floor muscles more effectively when moving. She now has a healthy baby boy, something she did not think possible at the height of her symptoms.
Her story is not unique. A lot of women between the ages of 16 and 21 have the same issues with the trigger often being their first pelvic exam or intercourse. The trend now is to wait for the first pap smear. Alicia’s mission is to raise awareness of the benefits of pelvic physical therapy and I cannot think of a better person to go to than Alicia – someone who has herself been through it, too – an ally.
Men don’t get off the hook that easily! I have seen several men for pelvic pain and realize men have a little bit of a different set of circumstances. Keep in mind: there is, ahem, a “vas deferens” between men and women! This means the baseline muscles, nerves, and bones are all the same but a few muscles are reoriented based on the expressed gender. Men can also trap nerves around the sits bones (ischial tuberosities) and also at the base of the penis around the pubic bone (not too dissimilar from vulvadynia). The pain can radiate to one side of the penis or one testicle, but can also include both. Men, like women, can have a hard time with sitting, walking, running, biking, and also intercourse. In no matter what case – male, female, or trans – some of the things that help in addition to those listed above is electromyography and biofeedback, with the focus on strengthening what is weak and relaxing those things that are tight. Nerves are driven by the brain, and if the brain is excited then so are the nerves. We can retrain things to move better and with less pain. t
Reach out to Alicia with your questions at firstname.lastname@example.org or 443-219-7683. You can also email me at email@example.com or call/text 443-742-0019 or even fax me at 443-345-3414. All good things start with a conversation. Let’s have yours today!