PA I D A DV E RT I S E M E N T
W Wome n’s Health ealth Symposium CHRONIC PELVIC PAIN PAIN IS A VERY INDIVIDUALIZED and
I recently had the opportunity to discuss this condition with a colleague, Dr. Smitha Vilasagar, who specializes in treating women with chronic pelvic pain. According to Dr. Vilasagar, many women see multiple physicians for evaluation of chronic pelvic pain before receiving adequate treatment. She states that pain is divided into two categories: acute or chronic. Acute pain is what happens when you bump your toe, burn your finger on the stove, or hit your thumb with a hammer. Acute pelvic pain can result from a ruptured ovarian cyst or a painful menstrual cycle. Typically, the pain can be linked to an event and improves with time. Chronic pain is much more of a mystery and can therefore be frustrating to patients and doctors. The most common sources for chronic pelvic pain are gastrointestinal, gynecologic, musculoskeletal, neurologic, urologic, or a combination of causes. The most common diagnoses are pelvic floor and vaginal muscle spasm, endometriosis, pelvic adhesions, irritable bowel syndrome, and painful bladder syndrome. The evaluation of chronic pelvic pain begins with a thorough history of the pain and assessment on the impact that the pain has had on a woman’s life. This could include the inability to attend school, work, or social functions. In severe cases, the pain can limit activities with kids, family, and intimacy with a partner.
DR. SMITHA VILASAGAR
In addition to discussing the impact of pain on quality of life, a physical examination is performed to better localize the area of pain. Imaging with either an ultrasound or CT scan of the abdomen and pelvis often follows the physical examination. Blood testing may be performed in some cases. The evaluation may involve a pediatrician, family physician, gastroenterologist, urologist, or gynecologist, depending on the initial presentation. A gynecologist to assess the female pelvic organs will eventually evaluate most women.
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subjective experience. For some, a stimulation or touch can be pleasant, soothing, or even sensual while others describe the same experience as painful or unpleasant. Chronic pelvic pain is an unpleasant sensation and emotional response to a feeling that is constant or recurring for at least six months. Pain can be influenced by culture, emotions, past experience, and type of trauma. The American College of Obstetrics and Gynecology reports that approximately 15 percent of American women suffer from chronic pain. The cost of medical care and lost wages due to time out of work is nearly a billion dollars per year in the United States.
In the past, this often resulted in women undergoing a laparoscopy, or surgery to look inside the abdomen and directly visualize the pelvic organs. According to Dr. Vilasagar, this is no longer the routine because studies have shown that women with normal testing usually have normal findings at the time of surgery, and the surgery isn’t always beneficial even in the instance where early endometriosis or adhesions are found. This is a hard concept for many of her patients and physician colleagues to accept. In her experience, most patients want an explanation for their pain as much as they want a cure. Because the “why” is so elusive in many cases of chronic pelvic pain, we try to focus on treatment as soon as possible, she states. Currently, the treatment of chronic pelvic pain involves hormonal medications to suppress the menstrual cycle and an interdisciplinary team of specialists including gynecologist, urologist, gastroenterologist, primary care providers, sex therapist, women’s health pelvic-floor physical therapist, massage therapist, acupuncturist, family psychotherapist, dieticians, and life coaches. Strong pain medications like narcotics are rarely of benefit long term and their use is discouraged. Because nearly half of women presenting with chronic pelvic pain are diagnosed with more than one diagnosis, a comprehensive approach provides resources to address all of the potential areas impacted by the chronic pelvic pain syndrome women experience. Unfortunately, we still don’t know all there is about this common condition. If a woman is suffering with chronic pelvic pain, I recommend she be seen and evaluated by a gynecologist and referred to a specialist who is engaged and committed to caring for women with chronic pelvic pain.
DR. G. BERNARD TAYLOR is an assistant clinical professor at the University of North Carolina School of Medicine, and assistant program director of the Carolinas Healthcare System Female Pelvic Medicine and Reconstructive Surgery fellowship program in Charlotte. He is a fellow in the American College of Obstetricians and Gynecologists, and board-certified in obstetrics and gynecology and in female pelvic medicine and reconstructive pelvic surgery.
Dr. Vilasagar and Dr. Taylor practice at the Women’s Center for Pelvic Health; 704.304.1160 or 704.403.6350.