Pelvic pain is a lived reality for sufferers everywhere. Vogue Singapore speaks to global health experts about pelvic pain in hopes to challenge the stigma, build awareness and break taboos around the condition.
With women’s health concerns often brushed under the carpet by society, there is no better time to get health authorities’ attention and start an honest conversation. A recent survey found that more than four in five women were not listened to by healthcare professionals.
Many women reported that their symptoms were not taken seriously, that they had to persistently advocate for themselves to secure a diagnosis, and if they did secure a diagnosis, there were limited opportunities to discuss or ask questions about treatment options.
“Pelvic pain is such an under-appreciated and poorly understood topic, not too dissimilar to many of the conditions that cause pelvic pain in the first place. Hence, having an awareness month is crucial in raising understanding and drawing attention to something that one in six women will suffer chronically with. That means not just occasionally, but potentially every single day of their reproductive life, and possibly beyond,” Dr Larisa Corda, London-based obstetrician and gynaecologist, tells Vogue.
According to an article published in Clinical Obstetrics and Gynaecology, women with chronic pelvic pain use three times more medication, have four times more surgery and are five times more likely to undergo hysterectomy than women without the condition.
“Unfortunately, the debilitating pain often persists despite these treatments, leading to an inability to work, economic burden due to repeat doctor visits, an unhealthy reliance on painkillers, impacted intimacy due to painful sex, repeated misdiagnosis/mistreatment, and being told that the pain is ‘in your head’, all of which increase the risks of psychological disorders,” Singapore-based consultant vascular and endovascular surgeon Dr Sriram Narayanan says.
What is pelvic pain?
“Pelvic pain is the discomfort felt below the belly button and above the pubic bone. This can include pain at the time of a period or ovulation (when the ovary releases an egg). Many people who menstruate will feel some pelvic pain or discomfort. However, it’s not only gynaecological conditions such as endometriosis or adenomyosis that can cause pelvic pain. There are conditions of the bladder and bowel that also cause pelvic pain,” explains Dr Martin Hirsch, consultant gynaecologist and endometriosis surgeon at Oxford University Hospitals.
Common causes of chronic pelvic pain include pelvic venous disorder (PeVD), painful bladder syndrome, (formerly known as interstitial cystitis), ovarian cysts, irritable bowel syndrome (IBS), pelvic floor muscle myalgia diagnoses (such as levator ani muscle syndrome), pudendal neuralgia, vulvodynia, and persistent genital arousal disorder—to mention a few.
When seeking help, it is important to pinpoint when your pain occurs and with what it is associated with, so medical healthcare professionals will better understand the cause of the pain and conduct the best test or treatment possible.
“If a person gets pain during their periods only, this may represent endometriosis or adenomyosis, while if someone experiences pain throughout the month, but only when passing urine, it may point towards a bladder pain,” Dr Hirsch adds.
Symptoms of pelvic pain
Los Angeles-based Dr Heather Jeffcoat, President of the Academy of Pelvic Health Physical Therapy and Advisory Board at International Pelvic Pain Society, lists nine symptoms of pelvic pain:
1. Nausea and vomiting
2. Severe or chronic constipation
3. Bladder pain (also presents as urinary frequency and formerly known as interstitial cystitis)
4. Rectal pain
5. Heavy periods with clots larger than the size of a Singaporean 20 cent piece
6. Extreme bloating
7. Missing school or work because of pain
8. Painful tampon insertion or penetrative intercourse
9. Painful orgasm
What happens if pelvic pain is dismissed by an individual or misdiagnosed by a professional?
“A misdiagnosis leads to a delay in care. Endometriosis has an average of 11 years from first symptom until formal diagnosis. During this time, care is delayed, which leads to long-term changes in the central nervous system—a process known as central sensitisation,” explains Jeffcoat.
As Jeffcoat explains, the difference between acute and chronic pain is that when we have one instance of acute pain, our body can remove itself from the threat. Therefore, our brain does not really have to process much beyond the moment of pain followed by the resolution.
However, when we have chronic pain, our bodies can’t remove itself from the ongoing threat (e.g. endometriosis or other chronic pelvic pain) and our brains are continually processing this pain input. This phenomenon can turn things that weren’t previously painful into being unbearable, such as wearing tight jeans. Additionally, the pain can spread to a larger area.
When should one worry about pelvic pain?
“Some form of discomfort during a period is common. However, when this discomfort starts happening outside of a period or interrupts a person’s quality of life, we recommend seeing a GP or gynaecologist about it. This can stop someone from working, studying, or enjoying themselves socially. It’s important to stress that this is not normal and may represent conditions such as endometriosis. There are many treatments available for endometriosis, although there is currently no known cure. Seeing a GP or gynaecologist early can help to get a diagnosis, stop the pain symptoms, and improve your quality of life,” Dr Hirsch says.
When is it best to seek help?
“If there is anything behind it, quite often, the earlier a condition is diagnosed, the better the options for management. With the right intervention, you may even be able to stop the progress of the disease. We don’t yet have a tool that screens for all the possible causes behind chronic pelvic pain in women. It’s important to go for regular cervical smears and have regular STD screens if you’re not in a committed relationship. Some new screening tools may be available soon to look for other causes, but the most important barometer of your health is yourself, your symptoms, and how you feel. In short, if you’re worried, do not avoid going to the doctor because it may make a big and important difference to your life,” Dr Corda says.
4 expert-approved ways to manage symptoms of pelvic pain
As many as 30 per cent of women have reported experiencing pelvic discomfort at some point in their lives, and it is estimated that 10 million women suffer from chronic pelvic pain. Unfortunately, chronic pelvic pain is associated with a higher risk of psychological disorders, with findings showing that 50 per cent of women with the condition suffer from moderate to severe anxiety, while over 25 per cent have depression.
While expert psychological treatment is key in navigating the emotional impacts of chronic pelvic pain, patients can continue to improve their mental health at home. Dr Narayanan shares four ways to look after your wellbeing:
1. Exercising – Exercise is the best non-drug therapy for pain and it is highly advantageous for improving mental health conditions. Recommended workouts include core exercises and pilates, as they not only release the ‘feel good’ hormone endorphins but also strengthen the pelvic floor muscles to further reduce pelvic pain after clinical treatment.
2. Managing your stress Persistent pain can lead to increased levels of psychological stress. Learning how to deal with this in healthy ways such as meditation, journalling, or breathing techniques can make a difference in your comfort or pain level.
3. Distracting yourself Distracting yourself from pain with a fun hobby or past-time can help you feel good physically and mentally while connecting you with family, friends or people in local community groups.
4. Talking to yourself constructively Positive thinking can make a major difference in managing pain levels. Instead of focusing on the physically and psychologically debilitating aspects of chronic pelvic discomfort, remind yourself that you are comfortable, strong, and working towards living a productive, fulfilling and pain-free life.
Join the conversation and spread awareness. Follow and share posts from the International Pelvic Pain Society for year-round support. Follow and use their hashtag #pelvicpainaware. International Provider Directory can be found here.