What would you ask a pelvic floor physical therapy expert about exercise, or about the pelvic health as an athlete, if you had the chance? Don’t miss Amy Stein, founder of Beyond Basics Physical Therapy and author of Heal Pelvic Pain answer some commonly asked questions in a webinar hosted by well-renowned Jessica Drummond of Integrated Women’s Health Institute. Jessica is a nutritionist specializing in abdomino-pelvic health and dysfunction. She will be interviewing Amy on the athlete and pelvic floor dysfunction, treatment paradigms, and practical tips for relieving the under active and the overactive pelvic floor.
This might seem like an odd topic to post about, but when you think about it, there seem to be more and more products on the market for you to use on or in your vagina. These products promise a range of different benefits from pelvic pain relief, to making your vagina smell like a spring meadow in bloom. For any woman, especially one with pelvic pain, it can be difficult to navigate this marketplace and find products that are not only safe, but deliver on their promises. This post will serve as a brief introduction to vaginal products and their respective risks and benefits.
When I first started this blog post I thought it would be a brief blow by blow of different products, their intended uses, and their side effects. Little did I know that the politics, history, and business interests surrounding vaginal and intrauterine devices could fill a whole book, let alone a measly little blog post. I opened Pandora’s Box. In an effort to highlight the story behind these objects, beyond the what and how, I will be making this blog a multipart series. So, if you don’t see your favorite device, despair not, dear reader. It may be coming in a future post. So for now let’s explore the first two devices in our line up: pessaries and tampons. Onward.
Pessaries are devices that are inserted into the vagina that provide mechanical support for the pelvic organs when the muscles of the pelvic floor are not strong enough to support them. They basically do the work of the pelvic floor and can be used to treat stress incontinence (urinary leakage with increased abdominal pressure, like coughing laughing or sneezing), pelvic organ prolapse, ( a condition where the bladder, uterus, or rectum drops down in the pelvic cavity and causes increased pressure and discomfort).
Pessaries are a good option for women who do not want surgery. Women who have short vaginas, large vaginal openings, or prior repair of hernias may not be successful with finding an appropriately fitting pessary.
Pessaries acts like a little a buttress to hold up the organs of your pelvic floor to improve continence. Because we all come in different shapes and sizes, pessaries must be fitted by a trained professional to do their job correctly.
Pessaries are taking on an amazing new role in developing countries with reduced health care infrastructure. Pessaries can be used to prevent pre-term birth in mothers who may not have access to advanced Western-style neonatal intensive care units. In a study published in the Lancet, the use of pessaries spontaneously reduced the rate of preterm delivery. The implication of this finding is profound and far reaching. With the use of a $50 device, women who do not have access to proper medical care are more likely to carry their infants to term and deliver healthier babies. It’s really amazing.
As amazing as pessaries can be, they aren’t correct for all people. If you suffer from pelvic pain, the pressure from the pessary can increase pressure on the pelvic floor muscles (usually culprit for pelvic pain), and make your pain worse. Although this is disappointing, pelvic floor physical therapy is helpful to help reduce your painful trigger points in your pelvic floor as well as strengthening your pelvic floor muscles to reduce your degree of prolapse.
Tampons are familiar to most of us. They are thin cylinders that are inserted into your body to capture menstrual blood before it escapes the body. But, oh boy, are tampons and the social politics surrounding them complex.
Tampons come from the rather crude French word, tampion meaning plug or stopper. Tampons have been around in some form or another since well before the common era. Things such as rolled papyrus, and ferns have been used since ancient times to staunch the flow of menstrual blood.
The first modern tampon appeared in the US around 1933 by the Tampax corporation. It is estimated the American women use approximately 11,400 tampons in their lifetime and spends 6 to 7 years of their life menstruating (total bummer).
With that kind of use and ubiquity the safety of tampons is certainly a concern for women and parents of adolescent girls who have begun their cycle. In the United States, tampons are considered a grade II medical device, meaning they a subject to regulation by the food and drug association to ensure they are not only effective, but safe. Prior to 1976 tampons were not classified the way they are today and were not as rigorously tested to ensure that they were safe to use.
Anyone who has opened a box of tampons is probably aware of the little slip of paper that contains information on how to use tampons as well as Toxic Shock Syndrome (TSS). TSS is usually a result of the overgrowth of a nasty little bug, who goes by the name Staphylococcus aureus (S. aureus). S. aureus is carried in about 20% of people. These little microbes can cause a multitude of ailments from pimples, rashes, and food poisoning.
TSS is characterized by high fever, a drop in blood pressure, flaky skin, rash and muscle pain. It was first classified in 1978 and received a more precise definition in 1980. What is really fascinating about TSS is that it was found across the population at the time of its classification, in men and children (clearly, not regular tampon users).
The link between TSS and tampons came to light during the late 1970’s and early 1980’s. The tampon market ( an extremely lucrative and competitive industry) was entering a phase known as the “absorbancy wars”. In the mid 70’s and 80’s there were huge market pressures to produce a tampon that was not only cheaper to make, but also highly absorbent to compete with a market already saturated (sorry), with inexpensive and highly effective products.
In the mid 1970’s Proctor and Gamble released a highly absorbent tampon called “Rely”. This tampon was extraordinarily absorbent and distinct in its design from its competitors. The tampon contained synthetic gelling materials that absorbed massive quantities of menstrual blood. While this designed allowed the wearer security and protection from unintentional menstrual leaking, the gelling substance provided a great environment for bacteria to grow and flourish. Furthermore, the gelling substance was manufactured in cube shape which increased the surface area for S. aureus to multiply.
A new tampon put on the market today would qualify as a class II medical device and would be under much stricter regulation by the Food and Drug Association (FDA). Rely, however, debuted on the market before such regulation was in place, and therefore was under less rigorous testing.
All tampons on the market today have won approval by the FDA and should be considered safe, but there are a few common sense recommendations to keep in mind when using these convenient little pieces of cotton. Always make sure you are inserting your tampons with clean hands, whether or not you are using tampons with applicators, or digital (applicator-less tampons). Use the lowest absorbency to do the trick. Tampons that are too absorbent for your flow can dry and irritate the vagina, (not to mention a dry tampon is never a pleasant experience to remove). Change tampons regularly, and remove old tampons before inserting new ones. Remember tampons are only meant to be used during your period, if you feel like you are having discharge that needs to be absorbed, see your doctor as it may be a sign of infection.
That will do it for “Thing we put up there: Part 1”. Stayed tuned for our next edition. Ever hear of a pelvic wand or wonder what is the deal with douches? Well, put on your scuba gear, dear reader, we will be diving into those topics and more in future editions.
Lamers, B.H., Broekman B.M., et al; Pessary treatment of pelvic organ prolapse and health-related quality of life: a review. International Urogynecology Review. 2011. 22(6), 637-44
Goya M, Pratocorona L, Merced C, et al. Cerivical pessary in pregnant women with a short cervix (PECEP): an open-label randomised controlled trial. The Lancet. 2012. 379(9828): 1800-06
Viera A, Larkins-Pettigrew. Practical Use of the Pessary. Am Fam Physician. 2000 1;61(9):2719-26
Tampons for menstrual hygiene: modern products with ancient roots. October 28,2014
Vostral S. Rely and toxic shock syndrome: A technological health crisis. Yale Journal of Biology and Medicine. 2011. 84: 447-59
We love the way Kylstra’s writing is forthright and informative, and there should definitely be more sexual health writing out there like this! Read the article to learn more about vaginal tenting, G-spots, the vagina after birth, hymens, and much more. Remember, too, that vaginas come in all shapes and sizes and they’re all beautiful!
And, as always, never be afraid to discuss your body with your partner or with your healthcare professional. If you have any problems or questions, we at BBPT are always here to help, too.
This holiday season, love yourself and your vagina!
On June 9, we posted a fantastic YouTube video on our website entitled “Detox the Box”, a parody on a popular Justin Timberlake song from Saturday Night Live. This entertaining and informative video encourages viewers to request that Tampax, Always, and Procter and Gamble remove irritants from their feminine hygiene products by signing a petition.
As a pelvic floor physical therapist, I STRONGLY AGREE with their message. Vaginal irritants can cause vulvar and pelvic floor muscle irritation and pain. Natural-fiber pads and unscented products are healthier for the pelvic floor than scented products. Tampons appropriate for a particular menstrual flow should be used (rather than “playing it safe” with a larger than necessary tampon).
While on the topic of vaginal irritants, allow me to take this opportunity to mention several other DOs and DON’Ts
Wear loose fitting underwear that does not restrict blood flow to the groin (due to tight fitting elastic)
Sleep without underwear
Use fragrant free detergents
Use Dove bar soap, Neutrogena, or Basis
Use soft, white, unscented toilet paper
Wear loose/baggy sweatpants during exercise
Don’t wear girdles or support stocking pantyhose– they restrict blood flow to the perineum and limit necessary circulation
Don’t use a douche. EVER. Not pelvic floor friendly, to say the least
Avoid extremely hot water on the vulva
Never use a blow dryer on pubic hair
Avoid toiletries with fragrances, propylene glycol, and sodium lauryl sulfate
Avoid scrubbing the vulva while bathing
Refrain from wearing Spandex, thongs, and wet bathing suits
A happy pelvic floor contributes to a happier YOU! Have you discovered any unique or helpful products on your quest towards vaginal health?Please feel free to comment and share any thoughts you have about products that have contributed your pelvic floor health. The comment that receives the most “likes” on Facebook will receive a prize! And on behalf of your fellow females, please sign the petition to “Detox the Box”!
On rare occasion, I have heard patients comment (half-jokingly yet half seriously), “I wish I could just trade on my painful vagina for a new one.” Generally speaking, I do NOT promote that concept; instead, I promote pelvic floor physical therapy as a means to treat musculoskeletal related vaginal and vulvar pain.
However, on rare occasions, more aggressive measures may be indicated. For example, an individual suffering from neuroproliferative vestibulodynia (increased sensitivity and pain in the vestibule due to increased number of nerve endings, a congenital condition) may be an appropriate candidate for a vestibulectomy, a procedure that involves removal of portions of the painful tissue.
Recent stem cell research in North Carolina, as reported by this article in Refinery 29, provides promising results that may be transferable to pelvic pain. The study involves growing vaginal tissue which developed into functioning vaginal canals. The tissue was then implanted into the four study participants, all of whom presented with vaginal aplasia (incomplete development of the vagina in utero).
All participants were able to participate in intercourse after the implantation, and the two participants whose procedure involved connections to the uterus will hopefully be fertile.
This research is very exciting for the pelvic floor community, and the potential benefits that it may provide patients with chronic pelvic pain are aplenty. Could a similar procedure be developed for women with vestibulodynia? Only time (and further research) will tell…
Pelvic organ prolapse in women is when a pelvic organ drops from its regular placement in the body and pushes against the walls of the vagina. This is not uncommon in women nor is it necessarily untreatable or progressive. The most common type of pelvic organ prolapse occurs with the bladder, though it can also happen with the urethra, uterus, vagina, small bowel, and rectum.
Often pelvic organ prolapse happens because of a strain put on the organs in that region, as in childbirth or hysterectomy. As listed on WebMD, here are some typical symptoms of pelvic organ prolapse:
Pressure from pelvic organs against the vaginal wall.
Feeling full in the lower belly.
Feeling like something is falling out of your vagina.
Feeling a pulling or stretching in your groin area or pain in your lower back.
Since June is Pelvic Organ Prolapse Awareness month, make yourself aware of the causes and symptoms of POP. It’s nothing to be ashamed of and it’s something we at BBPT can help you with! Take a look at this video from POP Advocate Sherrie Palm’s POP Awareness Month series about POP and PT, and let us know how we can help you!
The diagnostic features of VBD include extreme pain upon attempted vaginal penetration, vestibular pain when touched with a cotton swab, and erythema (redness) in the vestibule. These are called Freidrich’s criteria. Treatment includes tricyclic medications (ex. amitriptyline) to alleviate pain, especially in cases of secondary VBD. Also, antiseizure medications (ex. carbamazepine) and anticonvulsant drugs (ex. gabapentin) have been used to help women with VBD. One should speak with their physician regarding medications and the possible side effects if they think they may benefit from this form of treatment.
Furthermore, physical therapy is a crucial component in treating VBD. The pain which results from VBD can be viewed as a stressor or assault to the pelvic floor muscles. In response to pain, the muscles in the pelvic floor can tighten and may even spasm as a protective mechanism to prevent further injury. However, the tightening of the muscles themselves can cause a cascade of problems including formation of trigger points, decreased muscle flexibility, skeletal misalignments, and additional nerve compression. Therefore, women with VBD should participate in physical therapy to help treat the secondary musculoskeletal dysfunctions.
Vestibulectomy, a surgical procedure performed to remove the irritated and vestibular tissue along with the inflamed nerve endings, should be used as a last resort and only if all the treatments have failed. The hesitancy surrounding this surgery is due to the fact that nerves tend to have better memories than we want them to have- the brain may still continue to perceive pain even from a severed nerve! (This is similar to the concept of phantom limb pain, and this is the reason why individuals may continue to feel the presence of a limb even after it has been amputated.) Therefore, since the initial success rate of vestibulectomy is only 60% (approximately), it should be reserved for individuals who are completely unable to participate in intercourse due to pain (if medication and physical therapy were unsuccessful). Fortunately, this procedure should not impair areas associated with sexual pleasure, and it has not been shown to interfere with fertility, pregnancy, and delivery.