5 responses to “A Refresher in Pelvic Pain”

  1. I think this is a great theoretical approach. My concern is finding affordable CBT and not having enough time for a full sexual history as well as HPI. Maybe a trial of pelvic physiotherapy with a follow up visit when the psychiatric elements could be discussed?

  2. Obviously trying to improve pelvic pain is key, but curious if there’s a role for finger-tip “self Paps” for these patients? Seemed to be a minor trend a few years ago, but haven’t followed the evidence – might be especially helpful in this particular group?

  3. Hi Colleen, thanks so much for bringing this forward. I completely agree with your approach. At the BC Women’s Center for Pelvic Pain and Endometriosis we base our care on the results of the “pain mapping” you describe. Then we can share with the patient if there is a musculoskeletal component (pelvic girdle, abdominal trigger points, pelvic floor myalgia), and markers for central sensitization like provoked vestibulodynia, tender bladder and IBS who are common comorbidities and need to be addressed in different ways. If dysmenorrhea and cul de sac tenderness are present, hormonal and surgical treatment is offered for endometriosis. We have shown in our research that medical and surgical treatment of the inflammatory pelvic events in endometriosis helps even in patients with signs of sensitization.

    This approach does not take very long and can be done in repeated visits in the primary care setting. Questionnaires available at pelvicpain.org are very useful to speed up the process. We do not focus on past trauma until we have a clear diagnosis through history and pain mapping of where the pain is coming from and we share the diagnosis with the patient. Many of our patients suffer from trauma from the medical system also due to the lack of diagnosis and repeated unsuccessful consultations, imaging and emergency visits.

    Once the patient understands what hurts, it is easier to know what to do about it and the relationship between patient and caregiver becomes productive.

    I am very grateful to you for bringing this up through a good knowledge translation tool like “This changed my practice”. I also want to point out that our BC Women’s Center only accepts patients who have seen a gynaecologist within the last 3 years due to the high demand. Keep up the good work you do in the community.

  4. Very interesting!

  5. This is definitely a “spread out over several visits” kind of thing in primary care. I’d never have the necessary time or space to do this all in one shot.

    Affordability and availability of pelvic floor PT and CBT is the major barrier to care. I’d love if we could make room in MSP for 5-10 PT sessions/yr.

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