His and Her Health

Hi Niva,

The extreme muscular pain I had after my 3rd pt session subsided. However one component has remained. I now have a muscular ache during pt sessions and during larger dilator usage that begins somewhere on the right side of my vaginal cavity and extends into my right glute.

It's very disturbing because I'm 100% positive I never experieced this type of pain with penetration before. It would be fine if it were just during pt or a day or so after, but it's every time I insert something sizable so it's going to negatively impact sex.

My pt said that my muscles are releasing faster on the left side than right (I can feel this is true when they work on me). And that one side of my pelvis is higher than another. Still this is definitely new pain.

What is the best way to approach this? Do I need more of the same kind of therapy or is it just going to make the issue worse? I don't know if they can somehow correct this by continuing to work on me? And should they continue with the same technique or a different one? Have you experienced anything like this? THey are doing external glute work on me also.

THanks!

Lotus, It sounds like there is a trigger point or referred pain. Often there is one side that is tighter than the other. Also, the whole pelvic girdle is probably re-adjusting now that is is finally getting corrected. It is hard for me to tell you what type of treatment is best as I have not evaluated you nor do i know what is being done exactly. It sounds like the treatment is proper. There are a lot of "hands on" techniques and different PTs may feel more comfortable with one more than another, so i cannot say technique is wrong or right in regards to this issue.
Is the pelvic level being corrected?
Are you doing pelvic floor drops to release the muscles?
Does the pain occur with smaller dilators?

The pain only occurs with the 3rd and 4th largest dilators, not the smaller ones.

Are pelvic floor drops when you inhale then exhale and lift the pelvic floor and then inhale and release it back down? If so then yes.

Occasionally they adjust the pelvic level,, kind of pressing one leg forward and the other back. THey also have me do gym exercises that stretch the glutes/thighs and some that I would build think strength in the area.

One of the pts there does internal work with kind of a press release action by having me move my thigh toward her. THe other does a little of that, but mostly pressing on her own with more of a stroking motion and occasional pressing while fixed in one place.

So can trigger points eventually be worked out manually sometimes? Or do they usually require some sort of injection? Also, is it possible to have a dormant trigger point that's kind of awakened by pt? Like maybe I didn't realize there was a trigger point there because I was never specifically pressed internally on my right side during sex before? Or is it possible I developed a new trigger point? When you work on trigger points with your clients, does the pain usually intensify for weeks before subsiding, or does it just slowly fade away?

Thanks!!

Yes, trigger points can be worked out manually without injections. I can't tell you if you have a new trigger point bc I don't know if it was there prior to PT or not. There is "nonactive" trigger points where they may not refer pain until they are touched.
If pain after PT continues more than 2 days then I think to myself that I may have been too aggressive. Pain for weeks, something is going on...

Hi Niva,

ANother random question. When I feel around in there my self I can feel a distinct pulsing. I am wondering if it's normal to be able to feel a pulse in there? I was worried that it could be a nerve pulsing or muscle continually twitching. It's strongest at a particular location that almost feels like a strand on the surface of the muslce, deep on my right side. I can feel it on the left too but not as distinctly. The majority of my pain is on the right. Is it possible therapy has aggravated my pudendal nerve? is the pudendal nerve on the anterior or posterior wall? Does it run down both sides of the pelvis or one?
Does ir run into the rectal area or any of the interior glute muscles or could it cause pain there?

Also, with the glute pain, i've developed some rectal pain, pain just inside the pubic bone, perineum, beneath the labia, and really intense hamstring/outer thigh pain, a little calf pain, and pain in the bottom of my foot--all on the right side. I am wondering if is possible the tight pirformas muscle is agravating my sciatic nerve? I know you can't really diagnose without evaluating me though.....

THanks!

Lotus, so a few things. Pudendal nerve is found on both sides (R and L). It is hard for me to say what is pulsing-what u r feeling, but yes it could be muscle spasm. What finger are you using to palpate? If you are using your thumb it may be your own pulse...
The pudendal nerve does have 3 branches(preineal, rectal and clitoral).
The piriformis lays right above the sciatic nerve so yes is often a culprit to Sciatica. But it sounds like there is maybe a glut max trigger point or tension in another hip rotator.

Niva

When I insert my finger into my vagina, the burning at the vestibule is so bad on the outside, but also over toward the top of where my thigh connects to the vagina, what is that - muscle?

Hi Niva,

When you said maybe I had a glute max trigger point, did you mean the trigger point was in the glute and affecting the vaginal muscles, or the trigger point was in the vaginal muscles and affecting the glute? Guess I will ask my pt, but I am trying to figure out if the botox would be more effective in the glute or vagina.

It's interesting because the pain I've experienced does seem to branch out in 3 areas like you mentioned the pudendal nerve does. Botox would only help the muscle, not the nerve right?

Should my pt be able to tell me whether it's the muscle or nerve bothering me or would my doctor have to do that?

THanks again!

smb456, there is an awful amount of connective tissue and fascia that is in that area. It sounds like you have generalized, not local pain. It sounds like you would benefit from some skin rolling in this area. I am not exactly sure where you are describing, but it may be some inner thigh muscles.

Lotus, I think you were talking about rectal pain. I was saying a glute trigger point may be causing referred pain to the rectal area.
As for botox, yes it specifically helps muscles. As the botox starts to work and release muscle tension, the nerves are more at ease and less compressed.

<small>[ 07-02-2009, 11:10 PM: Message edited by: Moderator ]</small>

Hi Niva

Its actually inside the vagina toward the sides almost where your thighs connect to your vagina if that makes sense?

Niva

Im not feeling that my pt is competent. Reading thru your posts I sense that you have alot of experience. Do you do evaluations, do people stay in the area where you are located to get treated? What is your success rate with PFD/vestibule/rectal pain

Also, when I sit too long, I get sharp jabby pains up my rectum - seems like they move around- is that a nerve or a spasm?

smb46
It may be the Obturator internus muscle which is a hip rotator: would you say around 3 or 9 O'Clock internally, slightly deep?
All new patients are evaluated whether they are local or not. Patients are mostly from all areas of NJ and NY, but if one choses to come from further there are hotels nearby.
Success is good with pain related to PFD. Do you a physician treating you currently? I am not sure if your rectal pain is nerve or muscle. Sharp usually describes nerve type pain, but you also say jabby which sounds like muscle...it would need to be evaluated. Are you getting rectal work too?

Hi Niva

It is the bones at the bottom of my buttocks when I press them they hurt. When I see long, I get sharp pains that seem to move around in the rectal area. My sphincer muscle seems like its compressed or tight when I sit if that sounds right and I have the vestibule pain. I was given different diagnoses so Im not sure exactly what I am dealing with. 1. Pudendal neuralgia 2. PFD
How much time normally is needed in pt to see results, I feel I am getting worse instead of better.
thank you

that is when I *sit long not see

I was about to say that there may be some pudendal irritation (or neuralgia)by that description, but again I don't diagnosis medical diagnoses and definitely not via forums! PFD is in relation to the muscles, so you can have both these diagnoses and a vulvar diagnosis.

Flaring initially with PT does occur, but should reduce some. You should hopefully not be flaring more than 1 or 2 days post PT. I like to see some results by 6-8 visits, but people are different...
You need to speak/communicate with your PT about feeling worse. What are they saying?