Chronic pelvic pain (CPP) is a significant health problem experienced by up to a quarter of all people identifying as women. The condition can be defined as persistent pain in the pelvis, however CPP is an umbrella term for many diagnoses (vulvodynia, interstitial cystitis, vaginismus…) and for symptoms located in the bladder, urethra, vulva, vagina, rectum, pelvic floor, perineum or abdomen. There is great variation in the symptoms and severity of this condition; the pain can be experienced as tenderness, to acute and intense. Chronic pelvic pain is the most common reason people who identify as women, are referred to a gynecologist.
CPP can impact a person’s physical, emotional, psychological and sexual health; it can compromise their personal relationships and ability to carry out daily activities. People with pelvic pain report fatigue, problems with sleep and lethargy and are more likely to experience depression or anxiety; they report lower self-esteem and feelings of shame, isolation, guilt. Some people experience pelvic pain outside of sexual activity, others may experience pain with sexual activity, and for others it may be exacerbated by this activity. For people experiencing pain with penetrative sex, this activity can become less about pleasure and more about fulfilling their perceived role as a sexual partner, keeping their partner satisfied or conceiving.
When working with folks experiencing chronic pelvic pain, I see my initial work with a you as making sense of the pain; in other words, understanding how the pain came to be and what factors may be contributing to or maintaining the pain today. During this process, we explore physical/medical factors contributing to the pain, your narrative of the pain, where it starts, intensifies and ends; we explore your experiences with the pain, your beliefs, attitudes, values and what the pain means to you, in your life – all this, so that we can better understand the pain itself. From this place of understanding, we can sort out how we want to focus our discussions in therapy.
Stephanie Aniol, MSW, RSW, psychotherapist