Urogenital and Pelvic Pain

Urogenital pain affects at least 25% of reproductive age women. This includes interstitial cystitis, endometriosis, vulvodynia, and then also dyspareunia--a term for painful intercourse, which is really common not just in postmenopausal women, but in premenopausal women. As a physiatrist, I am looking at rehabilitation strategies. For these women, we focus a lot on pelvic floor muscle treatment, and we have good evidence now that supports it in all these different conditions. So it almost doesn’t matter what the diagnosis is, the treatment will be quite similar for all these different subtypes.

If you have a chronic pelvic pain patient and you have diagnosed her (or someone else has) with interstitial cystitis, my pearl would be to send her to pelvic floor physical therapy. There is no risk and there is great benefit and that’s been proven with level 1 evidence. Don’t be afraid of these patients once they’ve finished their diagnostic workup, but go ahead and just send them. That’s a really simple thing as a primary care doctor: you just write on a prescription “pelvic floor physical therapy” and that’s it.