His and Her Health

Lisa, I have a patient currently who had a change with menstrual cycle after the block. It was definitely blamed on the steroids. She basically kept on getting her period. Her gyn put her on birth control pills totry to regulate it but it did still take a while. She had another block this summer, which was about a year after that last one which led to the changes. She seems to be doing ok this time around.
So, I just wanted to let you know that it is a common side effect.

best
niva

line,
Yes Botox helps many people, but occasionally it does not. Now what I was wondering is where were the injections, meaning to which muscles? It might not only be the dose but where the doctor targeted. Also, are you working with a physical therapist?

niva

Sorry to chime in little late here, but wanted to add some...

Holly, you mentioned doing well with PT until recently (past few weeks). Well I would say then continue with PT. If you have made this musch progress and only seen a recent plateau I suggest keep going. It is not uncommon to hit some plateaus along the way.

As for those who have done PT for 6 months and no progress well you can always try for a second (PT) opinion, but yes I would expect a patient of mine would make some progress within 6 months (and even before this).

For those in PT or PT in the past, are your spines and entire pelvic girdle being treated? The issues leading to pelvic pain and vulvodynia may be greater than just the pelvic floor.

As a PT I am not the one to decide if a patient is a candidate for surgery. if I think surgery may be an option for a patient, I do refer them to a specialist such as Dr. Goldstein. Unfortunately, I have seen and am currently seeing patients post surgery. On the positive note, none have pain as they did prior to the surgery. The bad side is they are dealing with pelvic floor tension and pain. All have greatly improved with PT post op and are more active, etc...

Also as a PT I do not prescribe medications or tell patients to go on medications, but I do tell patients what seems to have worked best with other patients. For example, in my office, I have noticed women with provoked vestibulodynia have done the best with Botox.

It sounds like many of you have been doing PT with qualified therapists based on your answers here and descriptions of your treatments. I am not sure how many of your PTs have worked with pre or post Vestibulectomies though.

For all in recovery currently, keep up the good work. For those heading to surgery, best of luck!

Niva

Great to hear today has been a better day. This will get better and better! I commonly hear from patients post surgically of a "different" pain.

As for the bladder frequency, was that present prior to the surgery? I don't think you would get IC from this surgery. Some of the discomfort in general may lead to some more frequency. Hopefully your new doctor, the Urogyn., can help you out though!

Keep feeling good.

best, niva

Ms. Cindy, Usually after sugery (Vestibulectomy), if all is cleared otherwise, but pain conintues, it probably is the muscles. Again, I would recommend PT first before Botox, but if you do chose the Botox please combine it with PT.

As for TENS, I don't usually use it with women with vulvar pain. I do use it if there is low back pain along with their pelvic pain or in other women with bladder pain or abdominal pain post (abdominal) surgery or C-section. There are internal electrical stimulation units that also have pain settings, which would be more direct to the vaginal pain. I don't use them often but in the past it was like a 50-50 result; some good, some nthing (never worse though).

Good luck!
niva

Ms. Cindy,
Just a few things come to my mind after reading some of your posts. You mentioned wanting to try TENS for the muscle tension. I like using TENS units with my patients as an adjunct to Yes pain reduction overall may help reduce tension as one is less likely to guard, but the TENS again is for pain.

Also, you mentioned a new doctor you have seen suggested Botox, which means you have muscle tension (it sounded like you questioned this previously or your former doctor did not think this was the case). Anyway, have you tried PT? I highly recommend if you do go with the Botox you aslo work with a pelvic floor PT. I do know some doctors will not perform these injections without a patient being able to see a PT.

good luck
niva

Leanne, sorry to hear that you are still dealing with these issues. Have you ever trued working with dilators. You can get them smaller than a tampon and work your way up. The can help you learn to insert something into the vagina, which seems now to be sensitive and teach this area that it is ok to have touch and insertion. You can also try to find a physical therapist specializing in pelvic floor work and pelvic pain. They can evaluate if there is scar tissue that has thickened or if there are muscle spasms. If all these do exists, treatment with PT can really help!
best
niva