What is chronic pelvic pain?

Chronic pelvic pain (CPP) is experiencing pain in the region between the belly button and mid-thigh for longer than three months. CPP involves and affects all of our physical systems: gynecology, urology, gastrointestinal, neuromuscular, physiatry and physical rehabilitation medicine, pelvic floor physical therapy, pain management, and – my personal favorite – the brain and the mind-body connection.

CPP affects more than 30 million females in the United States, and an unknown number of males. Only 30-50% of patients are accurately diagnosed, and even less receive adequate treatment. For those who do, it often takes 5-7 years before they find a provider that guides them on an effective healing path.

What’s the deal, yo?!

One of my biggest frustrations is the lack of adequate training, useful funding for research, and apparent disinterest in providing the resources needed to boost not only our understanding, but our confidence in our ability to treat CPP. As a Board Member of the International Pelvic Pain Society (pelvicpain.org), professionals want to attend scientific meetings, but most feel allergic to the conversation of pain, let alone sexual pain. Comparing the amount of funding and sponsorship we get compared to other similar conferences, such as PAIN Week and ISHWSH, we discover that pharmaceutical and corporate companies prefer to offer money towards pain and sex, but not when the two are combined.

Painful sex = no fun = no funding.

On the contrary, my colleagues at the IPPS are the most incredible, fun, loving, compassionate, and willing-to-work-as-a-team professionals I’ve ever encountered. Once you understand how it’s all connected, it becomes a fascinating, challenging, yet simple jigsaw puzzle to recreate and inspire the body to return to its natural state of wellbeing and homeostasis.

Start by ruling out the obvious: the organ systems. Then move to the nerves and muscles – did you know there are nerves and muscles in the pelvis? You’d be surprised how many physicians seem to “forget” this. Granted, they are taught to zoom in and look at their organ system, and if they rule out the big dangerous stuff, then they point their finger at the organ next door. 

Then we need to remember that scans and tests don’t necessarily look at how these body parts function. You can’t see a muscle stuck in spasm or a nerve mis-firing on an x-ray, cat scan, or MRI. Furthermore, these tests don’t show you the emotional and mental state of the person (affects the entire autonomic nervous system = the overall function and coherence of our physical systems). These tests also don’t show you the past traumas, stressors, and learned experiences this person has absorbed, perceived, and filed away for reference.

Everything is connected – and it’s all connected in the pelvis. The pelvis is the main stabilizing machine of the body physically and functionally. We use the pelvis to move, sit, stand, pee, poop, procreate, and just about everything we do. The stuff inside the pelvis is always working: digestion, lymphatic drainage, reproductive organs, kidney and bladder function, and…drum roll please..the vagus nerve. I’ll talk more about the vagus nerve in a later blog. For now, know that the pelvis holds many of our vital organs that fluctuate in function and health based on our emotional and mental states. For example, stress creates the release of cortisol, increasing inflammation all over the body and specifically within the gastrointestinal system. This inflammation is spread through our circulatory system (the blood) to the brain, creating brain inflammation.

Brain inflammation leads to more fluctuations in our ability to emotionally self-regulate, which creates mental health symptoms such as anxiety, depression, obsessive-compulsive disorder, attention and focus impairments, and much more. Consequently, the autonomic nervous system remains in “fight-or-flight” mode, which keeps the cycle going, stimulating the vagus nerve to create sensitivity in the pelvic nerves and spasms in the pelvic floor muscles. Therefore, we need to calm the system from all angles. 

CPP requires an intradisciplinary team, which means not only seeing multiple different providers, but also providers that will work together in collaboration and support of all the other members. Furthermore, the multi-disciplinary care needs to be simultaneous for optimal effect and sustainable results. Yes, that means you may need to experience pain education, training in relaxation techniques, pelvic floor physical therapy, and other medical interventions all at the same time. Yes, it’s a lot of appointments and you’ll feel like you need a separate calendar just for your self-care regimen.