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Caitlin Whyte: Pelvic pain can come in a range of forms from mild to chronic. So what can people do to help find a solution? Joining us for this conversation and with some ideas on how to find relief is Dr. Erica Robinson, a fellowship trained, minimally invasive gynecologist and pelvic pain expert at PRISMA Health. This is Flourish, a podcast brought to you by PRISMA Health. I'm Caitlin Whyte. So my first question for you today, Dr. Robinson is what are some common causes of pelvic pain?

Erica Robinson, MD: So pelvic pain is a really common problem for a lot of women. It really impacts a lot of women and it's not something that they talk about a lot, but for causes, there are a lot of GYN or women focused problems of pelvic pain that can include a lot of things that people have heard about. Such as things like endometriosis, which can be up to about 70% of people who have pelvic pain might have endometriosis. It can be from old infections and we call those prior pelvic inflammatory disease or P I D, it can be from adhesive disease that they've had surgeries before. It can be from things like fibroids or there are other reasons that we may not know why somebody has pelvic pain.

It could be from muscular causes. It could be from bowel problems like constipation or inflammatory bowel disease or irritable bowel disease. And it could be related to very common things, especially now post COVID. Some things like depression, anxiety, our bodies store stress and things in weird ways. And that can come out as forms of pain, including things like pelvic pain.

Caitlin Whyte: When it comes to this pain, at what point should someone seek out medical help? Are there specific kinds of pain that are more of a red flag and should be treated more urgently?

Erica Robinson, MD: So when we think about pain, we think about chronic pain versus more acute or less chronic. Right? So when we think about chronic pain, that's pain, that's been there for at least six months. Both pains should be addressed. You should probably talk to your doctor about them because there's probably something that we can do so that you can get back to living your life. Hopefully in a relatively pain free state. For when you should seek help, definitely you need to seek help. If you have the really sharp pain, the kind of pain that wakes you up in the middle of the night.

The pain that keeps you from walking, the pain that makes you feel like you need to throw up, or if it's associated with other scary things. You might be pregnant, or if you think you might have an appendicitis, you've got fevers or chills, those are all things that you need to go to the emergency room right away for. We need to make sure you don't have a pregnancy in the wrong spot or an appendicitis or other things that need acute treatment. Pain has been present for six months, still you need to be seen by your doctor because there are probably things that we can do, whether it's from your muscles, whether it's from the uterus, whether it's from other things you should get in to see a physician, a gynecologist that specializes in pelvic pain to get you on the right track, to feeling better and get you your life back.

Caitlin Whyte: So let's focus on that chronic pain for a moment. How is that diagnosed and treated? And is there anything we can do to help our doctor arrive at a diagnosis?

Erica Robinson, MD: Oh, of course, of course. So diagnosis and treatment, when I teach with my resident physicians, the doctors that are, you know, almost OB GYNs, the first thing I tell them about patients with chronic pain is just to listen to the story, listen to what the patient tells you, what were they doing when they first felt this pain? And sometimes they'll say, I don't really remember, but ask them, were they in a car accident? Did they fall off a ladder? Was it, they first felt this pain during sex? Did they first feel this pain after they lost a significant other, right? What is it that may have triggered this pain?

Some people won't know and that's okay. But that helps frame the pain and what we're going to do about it. So really listening to the story. So, when patients can really tell me about their pain and describe it and talk to me about when they feel their pain and what makes their pain worse, that really helps me. And it helps me frame what they're going through and gives me a mental picture of that. So the diagnosis, a lot of it is based on what my patients can tell me. And then the other part portion of it is the correct physical exam, right.

And a thorough physical exam that not only is the standard GYN exam, where you think about how you just get your annual pap smear and things like that. But it's checking muscles. It's checking, if we move your leg a certain way, does that trigger your pain? Because you always get pain at the end of the day after you've been standing all day at work, right? Does that play a role in what your pelvic pain is doing? Is it related to your back? Is it related to your muscles and your abdomen? So we need to do a thorough evaluation of everything in the area. I'll ask you about sex.

I'm gonna ask you about your bowel function. I'm gonna ask you if it hurts when you pee, because we need to know what's going on everywhere around so that we can get you to the right treatment.

Caitlin Whyte: Now, another question I have about pelvic pain, is it normal for people to experience pain with intercourse and typically what would be the cause of that? I mean, what should someone do if they're experiencing pain with their partner during this type of sex?

Erica Robinson, MD: Right. And that's kind of a loaded question.

Caitlin Whyte: Yeah, there's a couple, there.

Erica Robinson, MD: So is it normal to have pain during intercourse? My short answer would be, and there's a lot involved in that and there's a lot involved in that for women, especially because for women, a lot of our sex drive is mental, right? A lot of what is involved in sex and being turned on and being involved in the moment is where are our heads at? So the short answer is no, if somebody's having pain with intercourse, I want my patients to come in and talk to me about that because I want that to be a pleasurable experience.

I don't want them to be scared of intercourse and I don't want them to feel guilty about having pain with intercourse either and feeling like they have to suffer through that. The causes of it can be kind of a vicious cycle. So once you feel pain with intercourse, then you get scared about having intercourse, which can cause more pain because you're anxious about it. And so you tighten up and it comes more painful. So it can be a vicious cycle, which is why I would recommend talking to your gynecologist or your pelvic pain doctor, which is what I would recommend for women to do.

Sometimes we don't know what the initiating factor is, but. For when you have pain and sometimes it might get better. It might be the certain time of months when things are a little bit more sensitive, but if it's a recurring issue, definitely talk to your doctor.

Caitlin Whyte: You know, in general, women are incredible health advocates for their families, but do you find that they aren't advocating for themselves when it comes to OB GYN issues? And why is that?

Erica Robinson, MD: Oh, it's so true. Isn't it as women, we will literally March for everybody in our family. Right. And take care of everybody around us. And then when it comes to ourselves, it's, we can put that on the back burner, which is why things like chronic pelvic pain can persist for months and years, and years and years before I sometimes will see a patient about it. Because we will suffer for years while we won't let our kids or our spouses or significant others suffer for more than a week. And so one of the things I always talk to my patients about is, I applaud them for coming in. Right. That's the first step. That's the hardest part getting in. And I tell them, you've gotta be your advocate.

You've gotta be your own advocate. I will advocate for you. But every time you come into a doctor's office, I need you to advocate for yourself. You've got to be strong for yourself and get the care that you need because these aren't things that we wanna talk about. For some reason, in our society and around the world, women, we don't really talk about sex. Right? We talk about it kind of jokingly in the social sense, but we don't talk about it when it hurts. We don't talk about when our periods really cause us a lot of pain or distress. We don't talk about the bad things. So it's hard and it's a scary thing. And sometimes the pelvic pain has a more traumatic history to it, right.

Maybe it's linked to a sexual trauma. And so, we don't talk about it for a lot of reasons, but finding a doctor that they can relate to and they can trust and open up to is part of that first big step. And I find that once they can make that big step, that they're much more willing and able to really be an advocate for themselves and get the care that they need. And I'm always so proud of my pelvic pain patients for that, but it is hard or I wish our society normalized it right. Or we could care for ourselves.

Caitlin Whyte: Oh, absolutely. I a hundred percent agree, but doctor, as we wind down, what can women do to better manage their health? And like you said, advocate for themselves?

Erica Robinson, MD: The things to do, we have reminders for everybody in our lives, on our calendars. Right. I tell my patients just when you see me or when you see your dentist, when you see your doctor for your annual, put it on your calendar for one year or two years to take care of yourself. To schedule time every week for yourself, whether it's 10 minutes or 30 minutes or five minutes, to take care of yourself. Even if it's to just sit in your bedroom and closing the door so that you just have no one else around you, but if it's not on our calendar, if it's not on our schedule and if we don't make an active effort to do it, we don't.

And so, I try to encourage women to actively manage their health, right. To be an active participant in that the way we actively manage the lives around us. So, that's one of the things that I talk to my patients about is to actively participate in that and to actively do that for themselves as well. And again, to really every time they walk into an office to remember that. They're the patient that they are taking care of themselves and they themselves have the right to ask all the questions. They get all the clarification that they would on behalf of anybody else. So to always remember that they really should advocate for themselves.

They really should ask those questions, never leave the office with any burning questions. I really do try to encourage them to really just own it. And also just to tell them, I'm always proud of them, right. To come into a gynecologist office is never fun. I hate going to my gynecologists office and they're usually one of my best friends, so I understand

Caitlin Whyte: oh, I love that so much. Well, doctor, thank you for an episode, just chocked full of great information. And for being on the show, we appreciate your time so much. For more information, head on over to Prismahealth.org/flourish. And this has been Flourish, a podcast brought to you by PRISMA Health. I'm Caitlin Whyte, stay well.