Most women, at some time in their lives, experience pelvic pain and/or vaginal pain. Women with symptoms of pain may want to see a gynecologist if pain is severe or if the discomfort doesn’t go away after a few days. Workup should begin with a careful history and examination. Some women may also need blood work or additional imaging studies such as an ultrasound, and a handful may benefit from having surgical evaluation using laparoscopy.
Dysmenorrhea refers to painful periods i.e. menstrual cramps. The condition is usually not serious, although it can sometimes be caused by infection, endometriosis, or ovarian cysts. This condition can be treated although it may require prescription medications. Painful periods can sometimes be eased by using heating pads or taking a warm bath. Exercise may also help prevent or manage the discomfort. Over-the-counter pain relievers such as Advil or Aleve can also help with the pain. If these methods are not successful, a physician can prescribe hormones such as the birth control pill or use the progesterone IUD to make periods less painful and/or less frequent.
When pelvic pain persists for longer than 6 months it is called chronic pelvic pain (CPP). This is a poorly-understood condition that likely represents abnormal neurological function, either in the peripheral nervous system or central nervous system. Determining what is causing the discomfort may be one of medicine’s more puzzling and frustrating endeavors. Endometriosis is the most common cause of chronic pelvic pain, but sometimes treatment of the endometriosis does not relieve the pain, and pain level is not indicative to the amount of disease present. Many women who experience chronic pelvic pain never receive a specific diagnosis. If a doctor can determine the source of the chronic pelvic pain, then treatment can focus on eliminating that cause, but there is often no quick and easy fix If no cause can be found, then treatment for chronic pelvic pain focuses on managing the pain. Pelvic physical therapy is often a useful treatment for chronic pelvic pain with little to no side effects.
Vaginal pain is very common in menopause women. It is usually caused from the lack of estrogen leading to dryness, thinning of the vaginal tissue and loss of elasticity in the vagina. Sometimes vaginal lubricants are adequate to relieve the discomfort but often these are not effective in treating painful intercourse. Topical vaginal estrogen products come in a cream, ring, or tablet. These are very effective in relieving vaginal pain related to menopause. A new laser treatment called the Mona Lisa Touch is also very effective in restoring the vaginal tissue to it’s premenopausal state without hormones.
Vaginal pain unrelated to menopause and dryness is frequently caused by spasms of the muscles surrounding the vagina. Pelvic physical therapy and/ or vaginal dilators can be very effective treatments.
Advanced Reproductive Medicine & Gynecology of Hawaii
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