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Why this OB/GYN wants to break the taboos of talking about pain 'down there'

Talking about pelvic and vaginal pain is still uncomfortable, Dr. Jen Gunter says, and women are often ignored.
/ Source: TODAY

For many women, lower back pain, discomfort during sex or peeing a little when sneezing occur all too frequently. Many ignore these symptoms or simply think they're just part of being a woman.

Talking about pelvic pain — and finding help — can be very challenging. But Dr. Jen Gunter wants women to expect better.

“Pain is unfortunately misunderstood, it’s not well taught in medical school," the author of The Vagina Bible: The Vulva and the Vagina: Separating the Myth from the Medicine told TODAY. "We haven’t known as much about it until relatively recently.”

“Chronic pain, as a whole," she added, "is probably universally dismissed in everyone.”

What causes pelvic pain and why it's hard to diagnose

Pelvic pain is extremely common: Anywhere from 14 to 32% of women of childbearing age worldwide experience chronic pain in their pelvic regions, according to the Eunice Kennedy Shriver National Institute of Child Health and Human Development. Some of the most common causes include:

  • Endometriosis — A condition that occurs when uterine tissue grows outside the uterus and forms painful cysts.
  • Muscle spasms — The pelvic floor muscles become “super tight.”
  • Interstitial cystitis — A chronic bladder condition that creates pressure, urgency and pain.
  • Pregnancy — Carrying a baby can strain, weaken or agitate muscles in the pelvic floor, causing aching pelvic muscles and bones.

Often pelvic floor physical therapy, a special treatment performed both externally and internally by female specialists, can reduce pelvic pain. Yet, so many women do not know it exists or feel afraid to ask about it.

What’s more, diagnosing pelvic pain accurately remains complicated, in part, because the pelvis is “really complex.”

Dr. Jen Gunter wants to break down the taboos associated with pelvic pain and help women get the help they need to feel better.
Dr. Jen Gunter wants to break down the taboos associated with pelvic pain and help women get the help they need to feel better. Courtesy of Peacock Alley Entertainment

“The pelvis has incredibly unique wiring, different from the rest of the body,” Gunter said.

In a small region at the base of the spine, known as the sacral spine, several organs “plug into” the nervous system. Nerves for the uterus, vagina, bladder, lower rectum, clitoris and skin all rest side by side.

“It’s like having a power strip,” she explained. “So, what happens is if you get pain in one organ, it can short the whole system out. Pain can travel along the nervous system to the spinal cord and it rewrites changes in the spinal cord and then it allows the other organs to have more pain.”

That could mean that a woman who originally experienced chronic bladder infections suddenly feels cramping in her uterus and lower rectum, even though there’s no infection or injury there, for example.

“Inflammation can travel like a computer virus to the spinal cord, causing all these complex rewiring that can change the whole system because all these organs are crammed together,” Gunter said.

To help women talk about their pelvic pain, she encourages them to think of it like a headache. There are numerous causes for headaches — allergies, tension, infection, migraine, or a brain tumor.

“That’s the same with pelvic pain,” she said. “Sometimes we have a specific medical condition … but sometimes we can’t find an organ producing pain.”

While treating an underlying condition helps many, some women feel frustrated when they learn that their condition is pelvic pain.

“It’s a problem in the nerves," she said. "Chronic pain itself can be the diagnosis and people have a lot of trouble with that. They don’t like being told their diagnosis is chronic pelvic pain.”

Why pelvic pain gets missed

Pelvic pain often gets ignored or goes untreated and Gunter said there are several reasons.

One is that women aren’t given the language to properly describe what’s happening. And, there's still shame associated with talking about their pelvic region's health.

“Women can’t talk about their body parts at a dinner party,” she said. “People aren’t sitting around saying ‘My vagina’s a mess.’”

When they do have the courage to talk to their doctors about pain, women are often ignored.

“Women’s concerns with pain during sex and things like that are dismissed,” she explained.

While that feels discouraging, Gunter said it’s important that women continue talking with their doctors (and friends) about their pelvic pain. Some women might turn to Kegel exercises to help with their pain, but because they have muscle spasms it just makes it worse.

“You want to get the correct diagnosis first,” she said.

Women don’t have to live in pain — or feel ashamed by their pelvic aches, Gunter added.

“If we can break down all the taboos, (we) make none of this uncomfortable,” she said.

When women do talk about their pelvic pain or pelvic floor physical therapy, it helps other women learn that their bodies are normal and there's treatment available for their discomfort.

“If somebody knows about it, it’s not this weird freaky thing they never heard about. Then they are much more open to going (to therapy),” Gunter said. “That’s the power of talking about things.”