May is both Pelvic Pain Awareness month and Mental Health Awareness Month – coincidence?
I think not…
Here’s what we know – it takes too long for women with various pelvic pain disorders like endometriosis, bladder pain syndrome/ interstitial cystitis, vulvodynia and genito-urinary syndrome of menopause to get a diagnosis and adequate treatment.
How many times have women been told their pain is normal, its in their heads, it’s because they have low libido, that painful sex is normal (NO!!! IT ISN’T!!!) because their healthcare professional can’t find anything wrong, there mustn’t be anything wrong (insert frustrated emoji) or my personal nemesis…have a glass of wine and relax…..
While we know that not all people with pelvic pain have a history of trauma of adverse events, there is definitely a strong link – chronic pelvic pain disorders often begin with the experience of trauma, and co-exist with anxiety, depression, and sleep disorders, all of which need a biopsychosocial approach rather than the traditional biomedical one. But also with newer onset pelvic pain conditions such as endometriosis, dysmennorhea, vulvodynia or vaginismus, the evidence supports a bidirectional relationship between anxiety and depression. Pain catastrophising, fear of pain, hypervigilance, increased sensitivity to pain or even touch, lower self-efficacy, negative attributions about the pain, avoidance, anxiety, and depression may lead to greater pain intensity…
We know that all pain experiences are translated and processed in the brain and are impacted by the mind-body connections, but that doesn’t’ mean the pain is ‘all in your head’ or ‘imaginary’ or ‘ALL YOUR OWN FAULT’ (‘just relax’…).
We know that anxiety and depressive disorders, as well as sleep disorders, are strongly associated with pelvic pain disorders in women – but are we screening for them?
Although screening tools like the PCS or the DASS can be really helpful, I’m really glad to see a specific screening tool for psychological distress in pelvic health developed by Pontifex et al published earlier this year:
Amelia Mardon, PhD candidate with the Body in Mind Research Group recently shared her thoughts in a superb infographic, highlighting the need for better recognition and treatment of the intersection of pelvic pain and mental health.
Around 60-80% of people with persistent pelvic pain experience depression and over 65% have reported to experience anxiety (Siqueira-Campos, V.M.E., et al. 2019, ‘Anxiety and depression in women with and without chronic pelvic pain: prevalence and associated factors’, Journal of pain research, vol. 12, pp. 1223-1233.
On top of this, females with pelvic pain experience greater levels of catastrophising, loneliness, and lower quality of life. ( Sewell, M., et al. 2018, ‘Chronic pelvic pain – pain catastrophizing, pelvic pain and quality of life’; Stout, M.E., S.M. Meints, and A.T. Hirsh 2018, ‘Loneliness Mediates the Relationship Between Pain During Intercourse and Depressive Symptoms Among Young Women’)
WE HAVE TO GO BEYOND PAYING LIP SERVICE TO THE BIOPSYCHOSOCIAL MODEL!!!!
If you’re interested in a comprehensive approach to including a BioPsychoSocial approach to assessing and treating people with Female Pelvic Pain, from the perspective of the intersection of anatomy, physiology and a psychologically informed approach to Dysmennorhea, Endometriosis, Bladder Pain Syndrome/ Interstitial Cystitis, Pelvic Neuralgias and Vulvodynia/Sexual Pain, then I am inviting you to join us in the online Female Pelvic Pain Rehab course, for a truly deeper understanding of treating the whole person, who is dealing with persistent pelvic pain.
I’m currently completing my certification in Trauma Informed/Awareness Yoga – more on that soon! But in the meantime, if you’d like more insight into trauma awareness and pelvic health, here’s an interview I did with Lauren Mansell on the topic.
Until next time,
Onwards and Upwards,