His and Her Health

Hi Dr Goldstein,

Curious why you are not a proponent of trp injections. I have read alot of Travell and Simons and they suggest that alot of the external trigger points contribute to issues of vulvar/pelvic pain. Just injecting botox into the muscles does not address the external trigger points. And some may perhaps be to stubborn for merely pt to calm. My doctor recommends addressing areas such as gluteus max. and long. for referred pain to sacral area . This is just one example. So you have peaked my curiousity as to why you are not for addressing these important stubborn areas that may take much more time using just pt- prior to administering the botox?
thank you

S

I think the question was posed, but the anterior vestibule- is that not 6 o'clock?

Dr Goldstein,

I wanted to address your email about vestibulodyia that it can be caused by pelvic muscle spasms. My doctor actually told me it is the other way around- that the vestibulodynia causes the pelvic muscle spasms. I had posted an excerpt from I believe a Dr Zolnourn (a doctor in NC - Im not sure I have the spelling correct on that name) who also believes that PFM are secondary to the Vest. How are you certain that the PFM cause the Vest and not vica versa?

Do I need to highlight this area for a response? I put notices on several headers to flag for an answer on this one- not sure if its not highlighted if its over looked

Our doctors respond at their convenience since they all have busy office schedules and also travel to give lectures.. We do not choose which posts they will answer. Their participation is done as a courtesy.

ok

While one cannot ever be absolutely certain in medicine, I feel very confident that PFD can be the sole cause of vestibulodynia. The PC muscles attach at 4,8 o'clock in the vestibule and the transever perinei muscle attaches at 6 o'clock. If there is tenderness at these points only, then I believe the vestibulodynia is caused by pelvic floor muscle hypertonus. If there is generalized tenderness and PFD then the PFD may be secondary to the vestibulodynia or maybe a co-primary cause.

<small>[ 03-21-2009, 09:56 PM: Message edited by: Moderator ]</small>

Dr Goldstein,

Thank you for responding to my question. So if the PC muscles and the transever perinei muscle were botoxed would that eliminate the pain in the vestibule?

Also, the other question I had is does it not seem logical that there may be some kind of inflammation going on in the body - either nerve or IC etc to start the PF muscles to spasm. It just doesn't seem that PFM just start to spasm out of the blue or in response to stress otherwise I think that alot more people would be walking around with this issue? Thoughts?

Also how do you do the botox, throught the vagina or the buttocks? Can you reach the pc muscles thru the vagina? Do you numb the area first? Is it painful? How about risks? Did any women ever complain of incontinence?

thank you

Sarah

I would like to know this too as I am considering botox

Does the needle go thru the vagina or the skin on the outside? ugh, either ways seems painful:(

Botox is done vaginally. I do not believe the area gets number be4. Some say it is very painful others say it is bearable.

If pain in the vestibule is helped by elavil, does that always mean it is neuropathic in nature?

I think some doctors do in thru the behind why is that- it seems alot less painful for some reason to me- would it not be easier to reach like the pc muscles that way?

Niva,

I was reading Dr Gs response about the muscles connecting to the points in the vestibule. So what is the pain that ya feel at the vestibule is it nerves or muscles? I thought the pn inervated the vestibule? But his response sounds like its all muscular? I have pain at the bottom as well, elavil seems to help me, but after reading his response it sounds muscular, so why would elavil help?