What are the different types of pelvic pain?
There are many names for pelvic pain. Let's explore the different terms for pelvic pain.
Pelvic pain can show up in all sorts of contexts. Some people experience pain only with penetrative sex. Some people cannot physically have penetrative sex or speculum exams–it feels like there’s an impenetrable wall. Others have a constant kind of pain that impedes a lot of their everyday functioning. Between 10-24% of people assigned female at birth and 2-10% of people assigned male at birth have chronic pelvic pain (Twiddy et al 2017, Smith 2016).
There are many terms that are thrown around: vulvodynia, vaginismus, dyspareunia, chronic pelvic pain, pudendal neuralgia, chronic prostatitis. What are these different types of pelvic floor dysfunction, and how do they differ from each other? And most importantly, how do we treat them? We'll explore 3 of those terms here.
Vulvodynia is a more general term for pain around the labia, vulva, or specifically around the vaginal opening. Vulvodynia looks different in each client. Most clients will describe their pain as having a stinging or burning quality. Some people have pain constantly. Others will only feel discomfort when sitting for a long time or during/after sex.
The causes of vulvodynia are complex and vast, but may include pelvic floor muscle overactivity, peripheral nerve damage, central nervous system overactivity, hormonal differences, inflammation, lichen sclerosis, and other genetic factors.
Vaginismus refers to the involuntary contraction of pelvic floor muscles upon insertion. This can make sex difficult or sometimes impossible. People with vaginismus might feel like there’s “wall” that’s impeding their ability to have penetrative sex. People living with vaginismus might also feel pain during sex.
Vaginismus can be caused by a multitude of factors, including chronic yeast infections, bacterial vaginosis and UTIs, childbirth, trauma, hormonal changes like menopause, inability to produce natural lubricant, and/or pelvic floor overactivity.
Dyspareunia is a more general term that indicates pain with sex. Experiences vary but could include feelings of rawness, tenderness, burning, achiness, or dryness when attempting penetrative sex. Dyspareunia can be caused vaginismus and/or vulvodynia, as well as other contributing factors such as inadequate lubrication, chronic yeast or UTIs, interstitial cystitis, endometriosis, hormonal fluctuations, stress, trauma, lichen sclerosis, pelvic congestion, IBS, and more.
Chronic Pelvic Pain (CPP)
Chronic pelvic pain is pain that occurs anywhere between your belly button and the bottom of your pelvis for more than 6 months. This is a term is a catch-all that can encompass any of the types of pelvic pain above.
What can we do for vulvodynia, vaginismus, dyspareunia, and pelvic pain
As always, treatment varies depending on the individual. We address pelvic pain disorders through a variety of approaches, which may include:
Pelvic floor relaxation (it's harder than it sounds)
Internal manual work
External manual work to the abdominal wall, hips, and/or adductor regions
Stretching and lengthening routine
Pain science education
If you’ve been experiencing pelvic pain and/or pain with sex, it’s worth it to see a trained pelvic health specialist who can help address your pain from a holistic, client-centered perspective.
This article was written by Mirah Sand OTR/L. They are a pelvic floor occupational therapist who is certified Pregnancy and Postpartum Corrective Exercise Specialist, and has received advanced pelvic health training through Herman and Wallace Pelvic Rehabilitation Institute.
Twiddy, H., Hanna, J., & Haynes, L. (2017). Growing pains: understanding the needs of emerging adults with chronic pain. British Journal of Pain, 11(3), 108-118.
Smith C. P. (2016). Male chronic pelvic pain: An update. Indian journal of urology : IJU : journal of the Urological Society of India, 32(1), 34–39. https://doi.org/10.4103/0970-1591.173105