Persistent vaginal pain - 2 years after childbirth

[Nikki22]

Hi

I'm new to this forum. My problems all started 2 years ago when I gave birth to my third child. Ever since, I have had left sided pinching/throbbing pain just inside my vagina. I've been to two physiotherapists, a Urogynaecolgist and a Pelvic Pain specialist.

The Pelvic pain specialist has said it's likely to be soft tissue damage during the birth and this pain is making my pelvic floor muscles tense up. She thinks that over time things will improve.

I am currently taking Lyrica 75 mg per day but am still having constant pain. I've also tried topical creams from a compound pharmacy including Amitriptyline, Baclofen.

The medications do help, but some days they don't seem like they are helping at all!

Can anyone relate to this? Or give me some advise? I'm truly at my wits end and feel so alone and just want to get on with my life. Thank you for listening.

[Cardinal]

Yes, unfortunately, pelvic pain is very common, and starts for a variety of reasons. I have had pelvic pain for over 4 years. I can't sit anymore without taking methadone. And even with, Im lucky to sit over an hour. But I have pain along my entire pudendal nerve, and on both sides, so mine is a bad case. Were your physiotherapists pelvic floor therapists, as that is the first step - getting pelvic floor treatment? Did any of your docs or therapists say what they thought the problem was other than the one who thought it was "soft tissue" damage? And what type of soft tissue? Muscle, fascia, nerve, or ligament, etc?

If your pelvic floor therapist or doctor can identify a specific pelvic muscle that is where the pain is, you can have the therapist focus on releasing that muscle, and if she cant get it to relax, you can get a trigger point injection in it.

You havent shared much yet about what the medics did but if that's because they havent done much, then you havent been given appropriate treatment.

[Nikki22 in reply to Cardinal]

Hi Cardinal

Thank you so much for your helpful reply. I'm so sorry to hear you are suffering too.

My first step was to see a Womens Health physiotherapist, as I assumed that's who you go and see when you have problems "down there" after having a baby. She diagnosed me as having "overactive pelvic floor muscles" and gave me kegel exercises to do at home. This didn't help.

I have another appointment with the doctor at the Pelvic Pain Clinic (Dr Chia) next month, so I will ask her more specifically what 'soft tissues' are involved. Can she tell from just what I am describing to her? Or is there some type of imaging or test to see what is going on? Dr Chia specialises in pudendal nerve but she didn't think this was the case for me as she said I would have other problems too, ie bladder issues, painful sex etc, whereas I only have constant pain and tense pelvic floor muscles.

I have read online about more hands-on physiotherapy treatment and trigger point therapy, and I have been wondering if I should try and find someone here in Melbourne (Australia) who could help. Did this help for you?

I appreciate you taking the time to response to me, thank you

[Cardinal in reply to Nikki22]

Yeah, Kegels is not what you want to do for hyperactive pelvic muscles. You need the opposite - to get rid of the tension. A pelvic floor therapist (yes, the manual therapy) is what you need and what the doctor will likely be recommending. She will try to release the tight muscles. Some people get better quickly, others take a year to feel normal, and some dont get long term relief from the therapy because the muscles keep going back into spasm. It's the first step of treatment when you have pelvic pain. I've had a little improvement from therapy - my problem is that it took almost 3 years to find a good therapist. You may have to try a couple before you find one that you get results from. Or maybe you will get a good therapist on your first go.

The doctor you will see will likely do a pelvic exam and ask about your symptoms, and from that she can probably make a good guess. Imaging for this type of thing is very limited, however there are a couple options. I live in the USA so I dont know if they have the same there, but a couple pudendal/pelvic specialists here work with a radiologist who can do an MRN or an MRI that can show pudendal nerve entrapments and other maladies. I dont know whether the doctor will recommend this or not. May wait until after a course of therapy. I am guessing that your spasmed pelvic muscles are impinging on the pudendal nerve and irritating it. So it's not a problem with the functionality of the nerve, but it is irritated. But it could just be the muscle itself that is painful. The therapy would help the same amount in either case.

If you go to pudendalhope.info you can find a list of doctors in Australia (looks like mostly Melbourne) who are familiar with pelvic pain. And there is more great info there.

[Ny123 in reply to Cardinal]

Hi cardinal

I'm in the USA too. New York. Suffering from pelvic pain for about one year. All the same symptoms. I have just started with a pelvic floor pt and am hoping this will help. Where do you live and have your therapists helped you in any way. Thanks. M

[Cardinal in reply to Ny123]

M,

I live in the Chicago area. Yeah, pelvic floor therapy has helped to some extent. I actually just started seeing a different therapist at the same office, and I think she is just starting to help in the areas that my previous therapist wasnt as skilled in. If, after a few months, you dont feel that you have improved very much, you should try adding in or switching to another therapist. I have been to a total of 8 pelvic floor therapists, and out of those, 2 have helped. Since you live in NY, you must have heaps of good therapists, so if you do your homework, like it seems that you are, you should be able to find a good therapist rather quickly. If the therapy doesnt relieve the majority of your pain after several months, you will want to explore other options (nerve pain meds, seeing a renowned specialist to see about nerve entrapment, trigger point injections, etc.).

[Ny123 in reply to Cardinal]

Thank you so much for the reply. Unfortunately there aren't too many good therapists or doctors in ny. This is a field that not too many venture in. I am trying my best not to take too many meds. I take them on a need basis only. Ughh I get so depressed I feel so frustrated from this whole thing. I'm so glad that we have others to talk to about this. Thanks again. M

[Cardinal in reply to Ny123]

Are you in a small city in upstate NY, then? Because it looks like there are a lot all over the city and Long Island. Did you look at both pudendalhope.info and apta.org? Once you are on those sites, there are sections to find a PT who does pelvic floor. Also, there are even a lot more than what is listed on both sites. Even googling your city + pelvic therapy turns up results not found on those two websites. There usually are pelvic therapists even near smaller cities, you just have to do some research.

[Ny123 in reply to Cardinal]

Thank you. You have been very helpful. I'm so grateful I found this website. I found one close to me. This is all new to me and I hope it works. I'm keeping my hopes up and my fingers crossed. Thanks again. M

[Nikki22]

Thank you so very much for your advice, it's such a comfort to hear from someone who understands and is familiar with this type of stuff. It's not the type of thing I can talk to my family and friends about, as no one has heard of it!! Even two gynaecologists I have seen in the past have ever heard of this type of thing after childbirth....lucky me

I will prepare myself and have some more questions when I return to the Pelvic Pain Specialist Dr Chia next monthl. I will ask if she feels the right type of physiotherapy can assist me. i have already spent hundreds of dollars on physiotherapy, but obviously I haven't been to the right practicinioner yet.

Thank you again and I hope you are feeling comfortable today