Anatomy/Physiology Archives - Page 2 of 9 - Revitalize Physical Therapy

February 28, 2024

Dealing with Dyspareunia: Turning that “Ow” into “Wow!”

Happy late February, dear readers! I’m writing this to you shortly after Valentine’s Day, so maybe you’re basking right now in the glow that comes with having recently had some delicious chocolate, a nice dinner out, and a long, romantic evening with the one you love.

But a lot of you might not love Valentine’s Day because sex causes you pain. And, unfortunately, unlike Valentine’s Day, hardly anyone talks about that.

So maybe you blame yourselves. Maybe you blame your partner. Maybe you stop having sex. Maybe you’re too embarrassed to talk about it, even with a doctor. Maybe you’ve avoided dating because of it. The inability to enjoy one of life’s greatest pleasures could understandably make you feel depressed and hopeless.

But you don’t have to suffer!

First of all, take heart. Sex that hurts, otherwise known as dyspareunia, is common, so you are not alone. It happens to almost three out of four women at some point. It may even affect up to half of postmenopausal women. (Sex can hurt men too, but it’s rarer.)

So what causes it? While you should always see a doctor to get a diagnosis when you are experiencing painful sex, here are just a few possibilities:

Vaginismus happens when your vagina tenses outside of your control. It doesn’t only happen during sex. It can even happen when you’re just putting in a tampon. It may be caused by anything from anxiety to sexual abuse. Pelvic floor physical therapy can help, as can dilator therapy, CBT (cognitive behavior therapy), and sex therapy. (If you come to Revitalize Physical Therapy, we are happy to guide you in how to use dilator therapy to treat this!) Vaginismus can require some patience, but it can ultimately be resolved, as can vulvodynia.

And just what is vulvodynia? Well, it’s chronic pain in your vulva that goes on for a minimum of three months and doesn’t have a definitive cause. (Here is a diagram of the vulva for those who need it!) The Mayo Clinic describes vulvodynia as feeling like “burning,” “stinging,” “rawness,” or even a “sharp or knife-like pain.” Pain can also feel like it is constant or intermittent, be in the whole vulva or just a certain part. And while the medical community doesn’t know what causes it, some theories are previous vaginal infections, inflammation, pelvic floor muscle weakness, or pelvic spasm. Having vulvodynia and dealing with the fear of sex being painful might even lead to vaginismus! This can be a vicious cycle. Pelvic floor physical therapy, CBT and sex therapy can also help with this.

Then there is vaginal atrophy, which can affect middle-aged women: Decreased estrogen results in decreased lubrication, which can result in painful sex. If you haven’t had sex in awhile, that can also lead to atrophy, so again, if you are avoiding sex due to a painful sex condition, you may find yourself with another painful sex condition. (Vaginal atrophy can even be caused by antihistamines!) Treating vaginal atrophy can be as simple as using lubricant (which can help make sex more pleasurable) or you may need vaginal estrogen from your doctor. Dilators may also help.

I know that all this information is overwhelming, but it is worth taking the time to learn more. Proper diagnosis leads to proper treatment, and hopefully, by this time next year, you might be enjoying some sweet new memories of your best Valentine’s Day ever!

January 25, 2024

When They Don’t Have Time for Your Pain

Doctors are supposed to treat all patients equally, but sadly, sometimes they don’t. In fact, if you are a woman, you may actually receive worse treatment for your pain than if you are a man. If being in pain isn’t hard enough— add a doctor who won’t listen, and you can end up depressed, frustrated, and distrustful of the entire medical profession.

What kind of inconsistencies are happening exactly? Let’s take a closer look.

In a study of almost 1000 patients published in the Academic Emergency Medicine journal, it took women with abdominal pain in an urban emergency department 16 minutes longer than men to be treated. Women were also not as likely to be prescribed opiates. The study concluded that “gender bias is a possible explanation for oligoanalgesia in women who present to the ED with acute abdominal pain.” (Oligoanalegesia is just a fancy term for when pain is undertreated.)
A 2022 article in The Washington Post looked at studies that explored the inferior medical treatment received by women experiencing pain compared to men. This included enduring a longer wait time to be seen for a potential heart attack, or being told they have a mental illness when they had heart disease symptoms. “Among middle-aged women,” that study said, “31.3% received a mental health condition as the most certain diagnosis, compared with 15.6% of their male counterparts.”

And then there are personal accounts of women struggling for years to receive a proper diagnosis.

Broad City actress Ilana Glazer spoke of her battle to be taken seriously by doctors for pelvic pain. She went undiagnosed for two decades! “I remember being 15 years old and my mom and I sitting there and this doctor telling me that my problem was too problematic for him, and just feeling laughed at and so angry,” she said.

Essayist Carli Cutchin had to wait 11 years to be told she had a compressed pelvic nerve. The reason? Medical professionals simply didn’t believe that her pain existed.

Cartoonist Aubrey Hirsch created a comic about being told her ear pain was not significant enough to be problematic. However, when the male doctor looked closer, he discovered it was a ruptured eardrum with an infection. “Why didn’t you say you were in this much pain?” the doctor asked her at the end of the session, even though she had!

A few years ago, when Hillary Koplinka was feeling tired and achy, she was told to participate in yoga by her male doctor for what turned out to be Hashimoto’s disease!

Maybe you’ve heard stories like these from your female friends and family?

So what can you do? Although the onus shouldn’t be on the patient to get her doctor to listen, there are steps you can take to advocate for yourself.

Zocdoc suggests being thorough in keeping notes about “when, where and how” your pain occurs so you can describe it. Having another person validate your story is also important, be they a friend or relative. It can also help to parrot back the information the doctor shares during the visit.

Finally, don’t stop until you find a doctor with whom you are comfortable.

And if you are having pelvic floor dysfunction pain and live in New York or nearby, consider Revitalize Physical Therapy. You will receive top notch medical care from providers who know what you are going through! We will never dismiss your pain because we recognize that having the right team who takes you and your pain seriously can make all the difference.