Full Circle Blog:
Women's Health

Silent Suffering

Pelvic pain really hurts. It can affect women at any age, from the teen years to after menopause. The pain can be on the outside or deep inside. It can be constant or intermittent. It’s more common than you think, because women don’t talk about it very often—not to each other, and not even to their care providers. Even worse, GYN providers often don’t bring up the subject either—so women continue to suffer in silence.

Women can suffer from pelvic pain during sex; even if not sexually active, pain can affect their ability to get a Pap smear, use tampons, wear close-fitting clothes, or even sleep. The pain can cause stress in their relationships and affect their activities. It can even lead to depression.

Pelvic pain is one of the four areas of female sexual dysfunction, and it can contribute to the other three: difficulty with desire, arousal, or orgasm. If it hurts, why would you want to do it?  If you do decide to do it, how can you expect to have a good experience through the pain?

The good news is that there are providers who want to talk about this important issue, and there are treatments. In our midwifery practice, we always let women know we are comfortable talking about anything related to their sexual anatomy and function; and we let them know we can help.

We start by taking a thorough history of the problem. We want to know exactly what it feels like, when it started, what makes it better, and what makes it worse. We want to know if she has seen any other practitioners and what treatments she has tried, and we want to understand how the issue has been affecting her life.

Then we gather as much physical information as possible, giving each woman the power to control the exam according to her comfort level. If possible, the exam will include inspecting and feeling her outside (vulva) and inside (vagina, cervix, uterus, ovaries, and pelvic muscles.) We may take cultures to look for infection, and we may draw blood to check hormone levels.

There are many different reasons for having pelvic pain, so the treatment will depend on the cause. Infections may be treated with medication. Supplements, such as probiotics, may be given to support a healthy vaginal environment. Certain medications, particularly birth control pills, can contribute to the problem and may need to be stopped. Hormone deficiencies may be treated with creams, patches, or pills; we work with a compounding pharmacist who can make a formula of bio-identical hormones specifically for each woman’s needs. Pelvic muscle spasms can be treated by physical therapy; we are fortunate to have a physical therapist in our office who specializes in the pelvic floor, and we often work together. Women who have a history of physical or sexual abuse have additional issues that may contribute to their pelvic pain, and we may suggest a psychotherapist in addition to the physical treatments.

Midwives are knowledgeable and experienced providers of gynecologic care, and we are truly comfortable talking about uncomfortable topics—you can ask us anything! We pay close attention to the individual needs of each woman, and we want to forge a lasting relationship with our clients. If you have pelvic pain, we want to know about it, and we want to help you feel better.