Pain in Your Private Parts-When You Hurt Below Your Belt

Pain below the belt should never be ignored.  This blog will discuss a few causes which may cause “pain in your pouch” and should be reported to your doctor.

Pelvic pain

If you have difficulty with urination, pain in the pelvic area or between your scrotum and your rectum, accompanied by fever and flu-like symptoms, then you may have an infection in your prostate gland.  This requires an appointment with your doctor as this requires an examination of your urine and possibly receiving a prescription for a course of antibiotics.

Painful urination

If you have a burning sensation with urination and the frequent urge to urinate, you may have a urinary tract infection (UTI), an enlarged prostate gland or an early sign of bladder cancer.  This requires an appointment with your doctor as if an infection is identified, then you will need antibiotics since UTIs are the most common cause of these symptoms.  If you do not have an infection, you may be advised to have other tests to determine if something else is causing your symptoms.

Sudden testicular pain

If pain comes on quickly as a sharp quick to the groin and feels like a dull ache and make walking difficult.  The sudden onset of pain may be accompanied by swelling of the scrotum.  This condition may be a testicular torsion.  This condition occurs when the flow of blood to a testicle gets cut off.  This is a medical emergency as this condition requires surgical relief of the torsion in order to save the testicle.

Bottom Line: Don’t take lightly any pain or discomfort in your private parts.  Your sex life might just depend on obtaining prompt medical care.

Urinary Incontinence-Don’t Suffer In Silence

Urinary incontinence is one of life’s most embarrassing problems. Millions of American women suffer from incontinence in silence. I see dozens of women every month with this problem and so many of them have been wearing pads and diapers for years because they were too embarrassed to bring up the problem with their physician. This blog will discuss the problem and why it is important to see a physician to get treatment.

There are millions of people who deal with the embarrassing and disruptive effects of urinary incontinence, yet it’s a health secret that is rarely discussed. Contrary to what a lot of people think, urinary incontinence is not a normal sign of aging. Yes, it is more common in older men and women but you don’t have to live with the problem as treatments are available.

There are several reasons for urinary incontinence, but for women, one of the most common is weakened muscles in the pelvic floor.
A woman’s body goes through many changes during a lifetime and weakness or injury to muscles in the pelvic floor can cause health issues for women of all ages. The group of muscles in the pelvic floor can be affected by aging, childbirth, posture or injury. This loss of support of the pelvic muscles can result in incontinence, pelvic pain, or pain with intercourse.

Weakened pelvic floor muscles can be strengthened with Kegel exercises. (see my website, http://www.neilbaum.com, for more information on Kegel exercises). For the problem of urgency and frequency and urge incontinence or overactive bladder, there are effective medications to treat this condition. Finally, for women with both kinds of incontinence due to weakened pelvic muscles, they can be treated successfully with physical therapy.

If you answer yes to any of these questions, you should speak to your physician as help is available:
Do you usually get a strong urge to urinate?
Do you always make it to the bathroom on time?
Do you leak urine when you sneeze or cough?
Do you leak urine during physical activity?
Do you get up more than once per night to urinate?
Do you feel heaviness in the pelvic area?

Bottom Line: If you’ve been keeping urinary incontinence a secret, you’re not alone. You don’t have to accept it. Help is available. Talk to your doctor.

Pelvic Pain-Perhaps There Is Light At The End of The Tunnel of Love

This blog will discuss the condition of vaginismus or severe pelvic pain which makes it difficult and often impossible for a woman to engage in pleasurable sexual intimacy. I will also discuss some of the common treatment options for this condition.

Vaginismus is caused by contraction of the muscles around the vagina making penetration difficult or impossible. Often the problem is caused by anxiety or worsened by the anticipation of pelvic pain. If a woman focuses on pelvic pain, her ability to concentrate on the pleasurable sensations of sexual intimacy may be affected, and often her sex drive will decline. This will perpetuate her pain, as decreased sexual excitement may lead to less vaginal lubrication and tight, contracted vaginal muscles, all of which may increase the unpleasant friction in the vagina during sexual intimacy. Emotional anxiety, which often results from painful sex, may have a negative impact on the sexual relationship. Sexual pain creates a vicious cycle, which needs to be addressed from multiple perspectives in order to be resolved.

Treatment often requires a referral to a physical therapist. Physical therapists are trained to provide treatment to restore function, facilitate movement, and most importantly, to relieve pain. Pelvic floor physical therapy is often helpful in the treatment of sexual problems in women.

A physical therapist may prescribe vaginal dilators to help overcome penetration anxiety and also to help gradually stretch the vaginal opening. Dilators are usually provided in a gradual manner starting with the smallest dilator that does not cause the woman any pain or discomfort.

Another treatment option is pelvic floor biofeedback. This involves the insertion of probe into the vagina. The probe measures the activity of the pelvic floor muscles and displays the activity on a computer monitor. The woman is able to visualize the activity of her vaginal muscles and learn to relax them as well as strengthen, stabilize, and coordinate the muscles that are used during sexual intimacy.

Finally electrical stimulation with a low voltage current can be useful to teach coordinated contraction of vaginal and pelvic musculature, and is useful in providing pain relief.

Bottom Line: Vaginismus is a terrible condition that results in loss of enjoyment in sexual intimacy, can impair a relationship between a woman and her partner, and can even lead to depression. Speak to your doctor and consider a referral to a physical therapist to help put the zing back into your bedroom.

Pelvic Pain-May Be Caused By Birth Control Pills

Birth Control Pills With Estrogen

Low-dose oral contraceptives might increase the incidence of chronic pelvic pain in young women, especially during sexual climax, a new study suggests. This is a side effect that is not discussed and is not in the package insert.
Current oral contraceptives contain very low-dose estrogen, which causes changes in serum estradiol, free testosterone levels, hormonal receptors, and vulvar mucosa. The researchers hypothesized that this could result in pelvic pain.

Low-dose estrogen users were significantly more likely to meet the criteria for a diagnosis of chronic pelvic pain than nonusers.

Bottom Line: If you have chronic pelvic pain and are using low dose estrogen birth control pills, you may want to speak to your doctor about changing your medication to a birth control pill that does not contain low estrogen.

When It Hurts Down There In the Prostate Gland-New Treatment for Chronic Pelvic Pain

Chronic pelvic pain is a disabling condition with multiple treatment options. However, in men with chronic prostatitis, which is not due to bacterial infection, have difficulty finding relief.
The symptoms of chronic pelvic pain are pain with urination, pain under the scrotum, and urinary frequency and urgency. Now there is a new treatment using trigger point therapy that has been helpful in some men with chronic pelvic pain.
In a study published in The Journal of Urology (Volume 185, page 1294), researchers evaluated the protocol, known as myofascial trigger point therapy and paradoxical relaxation training (PRT), in 116 men who had pelvic pain for several years.
Trigger point therapy, which involves applying pressure on a trigger point in a tight muscle until it “releases,” was performed by a physical therapist for 30 to 60 minutes daily for five consecutive days. A psychologist provided daily instruction in PRT for three to five hours. The goal of PRT is to reduce nervous system arousal in the presence of perceived pain and catastrophic thinking. The men were instructed to use the techniques at home.
At six months, their quality of life had improved significantly, and 82 percent of the men reported improvement in pain and urinary dysfunction. The improvement was described as major or moderate by 59 percent and as slight by 23 percent.
Bottom Line: If you have chronic pelvic pain with pelvic muscle tenderness that has not improved with standard medical therapies, consider asking your doctor for a referral to physical and behavioral therapists with experience treating this condition.

When Things Aren’t Right “Down There”-When Women Should Call Their Doctor*

For most women, a couple of irregular menstrual cycles or an occasional yeast infection are just a part of life — nothing that time or simple treatment won’t cure.  However, there are a few symptoms that warrant a call to the doctor.  This article will cover when you should call your doctor for problems “down there”?
1. Pelvic Pain
Pain at the time of ovulation, is referred to as Mittelschmerz.  However, if you have pelvic pain that persists or doesn’t ease with simple home treatment, call your doctor.
When a woman has chronic pelvic pain, doctors will check for benign uterine fibroids and endometriosis. They will also look for pelvic inflammatory disease, which usually appears as a triad of pelvic pain, vaginal discharge, and fever.
In addition, abdominal pain and vaginal bleeding may signal an ectopic pregnancy, in which a fertilized egg implants outside of the uterus.  This is a medical emergency and you need to visit an emergency room if you can’t reach your doctor.
Ovarian cancer is another condition that can cause pelvic pain.  The symptoms of bloating, pelvic pressure and frequency of urination for more than two weeks is a potential sign that you should be checked for a possible ovarian cancer.
2. Irregular Bleeding
If you’re not on any kind of birth control and you have irregular bleeding that lasts for more than a month or two, you should always be checked.  Irregular bleeding includes: periods that last longer than normal, bleeding mid-month, having two periods per month, bleeding after sex, and other unusual patterns.  Abnormal bleeding may stem from multiple causes that aren’t serious, among them, perimenopause or uterine fibroids or polyps.
If you bleed every time after sex, that may indicate that the cervix is being easily irritated especially if there’s some infection of the cervix.  Sexually transmitted diseases, such as gonorrhea or chlamydia, can cause cervical lesions that bleed with sex.
If you’re postmenopausal, be especially vigilant about any vaginal bleeding; it’s a potential sign of uterine cancer. Uterine cancer, compared to ovarian cancer, is extremely treatable. It’s very curable because it’s generally found in an early stage and it has an early warning sign, which is postmenopausal bleeding.
3. Abnormal Vaginal Discharge
Abnormal symptoms include a strong odor; an unusually large amount of discharge; accompanying itching, burning, or irritation; unusual color; or blood in the discharge.
4. Vaginal Dryness
Vaginal dryness in postmenopausal women or vaginal atrophy can cause spotting after intercourse. Because older women have less estrogen, their vaginal tissue thins or atrophies and becomes dry and irritated.  Not only does vaginal dryness make sex painful, but vaginal thinning also leaves women more susceptible to infections and can contribute to urinary incontinence.
Most women can find relief with estrogen creams, rings, or tablets that are applied or inserted directly into the vagina.
5. Sores or Lumps
Sores in the genital area may point to herpes, a sexually transmitted disease, or cancer. Symptoms of cancer of the vulva include unusual lumps, wart-like bumps, or red, flat sores that don’t heal. Sometimes, the flat sores turn scaly or discolored.
Bottom Line: Most problems “down there” are innocuous but you should know when to call your doctor.  These are the five most common symptoms that need your attention and that of your doctor. 

*Modified from WebMD, 4-20-11