Amy Stein featured in panel discussion about painful sex

Amy Stein, MPT, was featured in the January 2012 issue of the American College of Obstetricians and Gynecologists Update entitled “Dyspareunia: Diagnosis and Treatment”.  This discussion was moderated by Dr. John F. Steege, Director of the Division of Advanced Laparoscopy and Pelvic Pain and the University of North Carolina at Chapel Hill.  Providing a psychological perspective was Dr. Irving M. Binik, Director of the Sex and Couple Therapy Service at McGill University Health Center in Montreal.

This continuing education module highlights recent advances in the treatment of vulvar pain.  The paper discusses the relationship between IBS, interstitial cystitis, endometriosis, fibromyalgia, and pelvic pain. The doctors report positive results with the use of topical agents as an effective treatment option for vestibulodynia.  Physical therapy continues to be highly recommended as a treatment for pain with intercourse.  Debunked was the myth of pain at the vaginal opening being from a psychological origin.

The article finishes with this startling statistic: 24% of women have pain with sex at the vaginal opening 6 months postpartum.  These women don’t have to suffer or assume that “this is the way things are now”.  Pelvic floor physical therapists can work with muscle spasm, scar tissue, pelvic misalignment, and muscle imbalances to restore the optimal tissue relationships.

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Painful periods

Painful periods. It may not be just cramps.

Endometriosis is a disease that affects over five million women and adolescent girls in the United States.  It occurs when endometrial tissue, normally contained within the uterus, grows elsewhere in the body.  This tissue may migrate outside of the uterus and into the ovaries, vagina, bowel, bladder, rectum, and diaphragm.  During the menstrual cycle, endometrial tissue increases in blood vessels and surface area then sheds appropriately during menstruation.  For a woman with endometriosis, abnormal tissue growth outside of the uterus may also respond with the hormonal cycle.  The results of the displaced endometrial tissue is inflammation, scar tissue, and pain.  Scar tissue builds bridges between organs and the adhesions decrease the ability of the organs to slide and glide. The restricted mobility of the nerves, muscles, viscera and surrounding connective tissue can cause blockages and pain.

These abnormal growths can cause debilitating symptoms including unbearable menstrual cramps, pain with sex, pain with voiding, fatigue, diarrhea, constipation, bloating, and nausea. Some women will experience infertility.

Treatment options for endometriosis include pain medicine, hormonal treatment, surgery, and physical therapy.  Manual physical therapy has proven to be an effective treatment option for women with restrictions or decreased mobility due to endometriosis.  Visceral mobilization and soft tissue mobilization help free the restricted structures and decrease secondary muscle tightness.  Manual techniques do not prevent endometriosis, but decrease or eliminate pain by optimizing the available range of motion.

Surgical intervention is necessary for some women suffering from endometriosis.  Two common side effects of surgical intervention include constipation and urinary urgency.  Physical therapists trained in pelvic floor dysfunction are able to treat the musculoskeletal aspect of these voiding disorders.  Abdominal adhesions typically occur after surgical intervention.  Prophylactic post surgical physical therapy is beneficial to restore mobility, increase core stability, retrain posture, and advise appropriate therapeutic exercise.

March is endometriosis awareness month. Reach out to the women in your life in crisis.  End the myth “it’s just cramps that I have to deal with” and encourage them to ask their physician about their symptoms.  Sex doesn’t have to be painful.  It is important to get a proper diagnosis.  Musculoskeletal causes of pelvic and abdominal pain are very common and can be the reason for pain.

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