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How to ease Vaginal Pain

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»What is Genital Pain? 
Is pain in the genital area (vulva, vagina, clitoris) that occurs most often associated with penetration (coitus) or your attempt or other situations (cycling, sitting, riding) 
Genital pain usually presents as a dyspareunia or as a vaginismus 
Dyspareunia is persistent or recurrent pain with the intent of full penetration and / or vaginal intercourse 
Vaginismus is the persistent or recurrent difficulty of the woman to allow the penetration of the penis, a finger and / or an object within the vagina, regardless of your desire

»What are the consequences of genital pain? 
Such situations cause important discomfort and anguish in women that lead to difficulties in the personal sphere and in a couple. 
In general there is usually fear of pain (related to touch or intercourse or other times more generalized) that can lead to avoiding sex pain or loss of desire, some women continue to be receptive to sexual activity

»How is genital pain manifested? 
The pain may be superficial or introitus, in the middle vagina or in the deep vagina, before, during or after penetration (intercourse). 
Sometimes it is associated with pain on the clitoris or vulva to the touch, vaginal dryness, postcoital cystitis, burning, dryness or pruritus of the vulva.
This symptom often causes a lack or reduction of desire, excitement and orgasm. 
These symptoms can be primary (of all life) or secondary or acquired (the symptom begins after a past of painless intercourse)

»What are the causes of genital pain? 
These are usually of multiple origin:

1. Biological: Infectious, inflammatory, hormonal processes, anatomical, muscular, neurological, immunological and vascular alterations

    2. Psychological: History of sexual abuse, affective alterations; depression and anxiety

      3. Link: Loss of intimacy, inappropriate sexual play, partner conflicts, penile / vaginal anatomical incompatibility, sexual dissatisfaction and consequent inappropriate excitement

      " How is it diagnosed? 
      It is based on the interrogation investigating a history of inflammation or local infections, intensity of pain, from when it is suffered, in what circumstances it occurs, what situation aggravates it, etc. 
      To this will be added the physical examination through which the location of the pain, the tension of the perineal muscles, the presence of inflammatory signs or scars at the level of the vulva (episiotomy), the association of pain in the clitoris and in the vulva. Finally the diagnosis will be completed with the evaluation of the hormonal status and the psychological and relationship aspects

      »How is it treated? 
      Given the multiplicity of factors involved in the origin of the pain, the current tendency is to carry out a multiple treatment according to the case that considers:

      1. Reduction of the causative factors: candidiasis, chemical irritants, vaginal dryness, etc.
      2. Diminish the conditions that maintain it
      3. Decrease the tension of the muscles of the perineum
      4. Mitigate pain: local or systemic analgesia
      5. Mitigate anxiety associated with antidepressants, anxiolytics or muscle relaxants
      6. Improve local and / or systemic hormonal status
      7. Individual therapy, and / or couple
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      The genitals are one of the most sensitive areas in the body of any person, either male or female, so feeling pain in them is very annoying and uncomfortable. In the case of women, the so-called vaginal pain usually extends from the pubic area to the anus or is located only in the vaginal hiatus, in the area of ​​the vulva.

      When the discomfort lasts and lasts more than 6 months, this pain is defined as chronic and the treatment to be applied will be irremediably more lasting and with medium or long-term effects, so it is advisable to go to a specialist at the first symptoms of vaginal pain . We can consult the gynecologist in case of noticing any discomfort that worries us and thus ruling out inflammatory processes, infections or a problem of the internal organs.

      The treatments are very diverse and usually personalized according to each case. In many of them gynecological physiotherapy intervenes, since there are multiple studies that have shown that specialized physiotherapy in the gynecological field improves the quality of life of women with vaginal pain and inflammation and significantly reduces the symptoms related to this dysfunction.

      In this article, I will explain what are the main causes of vaginal pain and what pelvic floor dysfunctions could cause it.

      Contents

      Causes of vaginal pain and inflammation

      Endometriosis

      It is the main cause of pain in the pelvic area , due to the inflammation of the pelvic-abdominal tissues. Endometrial tissue nodules are located in highly innervated areas, such as the area between the uterus and the sacrum or the rectovaginal area. Adhesions and obturation of the pelvic nerves, responsible for pain, as we reviewed in the article dedicated exclusively to this ailment .

      Pain in endometriosis is located in the deep pelvis , mainly in the lower belly, area of ​​the ovaries and descends towards the groin and vagina.

      Vulvodynia

      It is chronic vulvar discomfort , appreciated as burning, punctures in the groin and vulva. No visible lesions are seen, nor neurological dysfunctions.

      The pain can occur spontaneously or chronic . In the first case, the discomfort appears during sexual intercourse, in gynecological check-ups, during daily hygiene, with rubbing with tight clothes or simply by sitting down.

      The causes of vulvodynia can be an obstetric injury , such as a tear of the vulva that has occurred in childbirth or a surgical injury. Fungal infections, cystitis, or frequent urinary tract infections may also increase the risk of vulvar pain.

      A traumatic episode in life, such as loss of employment, divorce, infidelity, death of a loved one ... can become somatized and cause pain in the most sensitive areas of the female body such as the vaginal area.

      Vaginismus

      It is a hypertonia of the superficial musculature and in some cases also of the deep musculature of the pelvic floor. The pain appears at the moment of penetration, during sexual intercourse, even making them totally impossible. The discomfort is also seen in any vaginal touch, such as daily hygiene or gynecological examinations.

      The pain is located at the entrance of the vagina or at the entrance and throughout the vagina. Patients usually notice burning, muscle tension in the pelvis, itching, weight sensation ...

      There are two types of vaginismus : primary, when the woman has never been able to maintain sexual relations; and secondary, when some traumatic experience caused a muscular spasm of the pelvic floor. In this previously published article you can find more information about vaginismus .

      Interstitial cystitis

      It is a condition that causes pain in the bladder, low belly, radiates to the groin and the urethro-vaginal area. The most common cause of interstitial cystitis are frequent urinary tract infections , bladder irritation. After passing through an infection, the bladder distends and can cause an increase in the frequency of urination, a burning sensation in the bladder, a feeling of needing to go to the bathroom constantly ...

      Inflammation of the bladder wall causes it to be unable to work properly, generates chronic pelvic pain, pain when the bladder is full and relief when empty. Apart from pain, the muscles of the pelvic floor weaken as it is exposed to a greater workload in order to retain urine and sustain more weight than the bladder exerts.

      To cope with this dysfunction, it is necessary to combine physiotherapy of the pelvic floor, changes of postural habits, and modification of the diet . The three aspects are fundamental to improve the quality of life.

      Genital prolapse

      It means that there is a decrease in the internal organs with respect to their physiological location .

      There are several types of prolapses, depending on the type of organ that has gone down: uterine prolapse, bladder, rectum or bowel loops.

      Patients usually have the sensation of weight, lump in the vagina, feeling of incomplete emptying, loss of urine or gas, frequent urinary infections, pain during sexual intercourse, pubic or perineal pain. Find more information about uterine prolapse .

      How to treat and relieve vaginal pain?

      In practically all dysfunctions that cause vaginal pain, the major cause is the hyperactivity of the superficial and deep pelvic floor muscles . In the treatment it is fundamental to relax the perineal area, the pelvic floor, the lumbar area and the superficial muscles of the pelvis, since it is closely related to the symptoms of the injury.

      Stretches to relieve vaginal pain

      In many cases, the patients present tension not only of the internal musculature of the pelvis but also of the entire lumbo-pelvic region. With these stretches you will help to lower the tension of these muscle groups and relieve vaginal pain.

      1. Stretching of the sacral-lumbar area

        Stretching of the sacral-lumbar area for vaginal pain

        Lie face down on the big fitball ball, support the forearms and feet on the ground. Try to stretch your legs and lower your trunk (rest your head on your hands). You will notice how the weight of the legs and the weight of the head stretch the entire lumbar area and the region of the sacrum. Stay in this position for 3 minutes breathing deeply . Then, get up slowly and repeat it one more time.

      2. Stretching of the perineal area and adductors

        Perineal stretch and adductors

        Sit on the fitball ball and separate the feet and knees more than the width of the hips. Walk with your feet (3-4 steps) forward leaving your pelvis almost out of the ball. You will notice that, when lowering the hips, your knees open more. In this position we noticed a strong stretch in the inner side of the legs (adductors) and in the perineal region. Breathe deeply, and as you breathe, bring the air to the rib cage, while releasing the air, push the knees out with your hands, causing more stretch. Stay in this position for 3 minutes .

      3. Stretching of the perineum and groin

        Stretching vaginal pain

        In the kneeling position, bring one leg to the side keeping the knee flexed. Support a hand on the ball to maintain balance. Take a deep breath and releasing it takes the weight of your body to the side (towards the leg you have opened). You will notice a strong stretch on the inside of both legs, on the groin and on the pelvic floor. Repeat 10 times for each leg.

      Now that you know how to relieve vaginal pain, you can make an appointment and start with them.

      Most recommended techniques to relieve vaginal pain

      In the consultation also many treatments are carried out to relieve the pain of vagina, to lower the tension of the pelvic musculature and to improve the state of the perineum.

      Vaginal pain treatment

      The most recommended techniques are:

      • Surface thermotherapy with heat : Heat compresses, mud, creams with heat effect, infrared lamps in the external areas, such as the lumbar, the sacrum, the groins, the pubis or the buttocks are applied. High temperatures calm pain and tension sensation. It is important to previously rule out any inflammation in the pelvic region since the heat could increase it.
      • Perineal myofascial techniques : As for example, perineal massage , which is taught in the consultation and then the patient can repeat it at home daily. The objective of the massage is to make the perineal scars more flexible if they exist and reduce the tension of the walls of the vagina.
      • Antalgic internal electrotherapy : Vaginal electrostimulation with vaginal probes and muscle relaxation programs.
      • Vaginal dilators : They are used to perform internal stretching of the walls of the vagina, to improve their proprioception and relaxation for penetration. It is best to use a water-based lubricant and hyaluronic acid  for this type of treatment. It will facilitate the introduction of the dilator and will reduce the sensation of pressure and discomfort.
      • Lumbar massage : Lowering the tension of the lumbar muscles and the entire back of the pelvis improves pain in the perineal region.
      • Techniques of the sacral pumping : The pressure is exerted on the sacral bone towards the patient's feet, coordinating it with the breathing. After this treatment, there is a great decompression of the sacrum and the spine and relief in muscular tension.

      If you have any questions about these treatments, get in touch and I will be happy to assist you.

      Before you start with vaginal pain treatment

      Before beginning home training or treatments in the consultation, it is necessary to make a prior assessment of the pelvic floor condition to determine the type of dysfunction and the most appropriate type of therapy for each case. In it we can review the degree of impact on the state of the perineum that has been able to have childbirth and the injuries that happen during this, such as an episiotomy, perineal tear, the use of some instruments or pumping in apnea.

      It is essential to practice proper exercise in pregnancy to avoid vaginal pain to the greatest extent and prepare the perineum at the time of delivery. In this preparation the fundamental thing is to tone the pelvic floor to avoid possible injuries, perform perineal massage from week 33 of pregnancy, stretch the pelvic floor with the device Epi-No from week 37 and practice breathing and physiological bids that are less harmful to the mother.

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