pelvicpain.org

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Make a Donation to Support the International Pelvic Pain Society Patient Resources and Handouts FIND A PROVIDER PLATFORM IS NOW LIVE! Disseminating Education About Management of Chronic Overlapping Pain Conditions Previous Next Share this page Share on Facebook Share on Twitter Share on LinkedIn Email More options Bookmarks Google+ MySpace Reddit StumbleUpon Tumblr Yammer About IPPS ... Professionals Engaged in Pain Management for People of All Gender Identities In 1995 a group of physicians met to discuss their common interest in addressing a gap in chronic pelvic pain research, diagnostics, support and treatment. After two years, the International Pelvic Pain Society (IPPS) was incorporated to serve as a forum for professional and public education. Since then, the IPPS has grown to include gynecologists, urologists, gastroenterologists, PM&R physicians, physical and occupational therapists, psychologists, social workers and other health professionals committed to a biopsychosocial and interdisciplinary approach to the treatment of conditions associated with chronic pelvic pain. Chronic pelvic pain (CPP) negatively affects millions of people across the gender identity spectrum throughout the world. CPP can impact a person’s physical, emotional, social and material well-being. There are many biopsychosocial contributors to pelvic pain and healthcare providers need special skills in physical examination and history taking in order to better evaluate and treat patients with this type of pain. Often, conventional medical and surgical treatments are ineffective, however, a range of new medical, surgical and mind-body therapies are available to help improve the lives of individuals living with CPP. Please join us in our mission to provide the highest standard of care for individuals across the gender spectrum who are living with chronic pelvic pain. With your help, we can continue to advance access to quality care and work with patients to support them with their health-related goals. In addition to promoting excellence in care IPPS, members receive additional benefits including a quarterly newsletter, regular research updates, annual meeting discounts, access to a network of providers and other benefits designed to enhance education, practice and research. Our primary goal is to recruit, organize and educate healthcare professionals actively involved in the treatment of patients who have chronic pelvic pain. To achieve this goal, our society: Serves as an educational resource for health care professionals and patients Promotes multi-disciplinary and biopsychosocial approaches to the diagnosis and treatment of CPP Promotes research and dissemination of research findings Menopause Comes with More than Mood Swings October 2, 2019 Menopause Comes with More than Mood Swings ...It Deserves its Place Among Chronic Pain Conditions At this year’s PAINWeek, the International Pelvic Pain Society (IPPS) led a track of educational sessions on managing distinct types of genital, vulvar, and overall chronic pelvic region pain. Georgine Lamvu, MD, MPH, who serves as Chair of the IPPS Board and works at the Orlando VA Medical Center, provided an update on new terminology in the field and addressed the specifics of genitourinary syndrome of menopause (GSM), a relatively recent classification that has a longer lifespan than previously thought. Updated Definitions Vulvar pain can begin at any age, said Dr. Lamvu, and what’s important for clinicians to know now is that there is a new classification for the specific type of vulvar pain known as vulvodynia . This type of vulvar pain must last 3 months or more without a clear identifiable cause, with potential associated factors. The International Society for the Study of Vulvovaginal Disease (ISSVD) and the IPPS updated the definition in 2018 to differentiate vulvodynia from general vulvar pain. The idiopathic condition must be a diagnosis of exclusion. Another updated definition, this one in the DSM-5, is for vaginismus. This term captures vaginal pain that lasts longer than 6 months and that is associated with intense fear or anxiety around intercourse and the tensing of pelvic and lower abdominal muscles. The prior definition was more psychogenic, noted Dr. Lamvu. We know now that vaginismus may have a musculoskeletal dysfunction component. Further, this condition cannot be attributed to PTSD, domestic violence, or other life stressors. “We are really looking at an intense psychological fear accompanied by musculoskeletal issues—anything else is not ‘vaginismus.’ Then there is GSM, which was previously known atrophic vaginismus, vulvovaginal atrophy, or urogenital atrophy. Although the disorder was described by the International Society for the Study of Women’s Health and the North American Menopause Society in 2014, and further explained by Gandhi J in an AJOG paper in 2016, many providers are still catching up with the fact that GSM is disease that progresses over time. The syndrome groupslower urogenital tract signs and symptoms associated with a low-estrogen state. The GSM pathophysiology has to do with changes in tissue integrity and the acidity of the vagina, and thus, reduced protection against vaginitis and urinary tract infections. Symptoms may include dyspareunia, incontinence, prolapse, thin vaginal epithelium, impaired smooth muscle proliferation, loss of vascularity, dryness, and itching—all occurring in the hyposterogenism state. Risk factors may include bilateral salpingo-oophorectomy, ovarian failure, chemotherapy, smoking, and alcohol use. “When you see someone with vaginal atrophy, you have to screen for urinary and sexual dysfunction, but now you can avoid any negative connotations associated with the term” said Dr. Lamvu. “Menopause may be identified as the cause of both vulvar andurinary symptoms with this condition.” Genitourinary Syndrome of Menopause—On the Chronic Progression Continuum Sharing the stats, Dr. Lamvu noted that 15% of premenopausal women experience GSM and 40 to 54% of postmenopausal women have GSM. Most of the symptoms have to do with declining estrogen levels, which change most rapidly between ages 45 and 55. Of interest, a review of 64 studies over the course of 2000 to 2014 around the world on menopause symptom prevalence found that 30 to70% of women experience GSM symptoms worldwide (see Makara-Studzinskia MT, Prz Menopauzalny, 2014). Sexual dysfunction post-menopause may go up to 92% prevalence. Women do not often mention sexual dysfunction in particular—they may mention dryness, said Dr. Lamvu, but providers need to talk to them about this symptom as well. The median vasomotor duration in another study was 7.4 years for symptoms of menopause; symptoms may go on 4.5 years after menopause as well (see Avis NE, et al, JAMA Intern Med, 2015). “Essentially, the earlier a woman starts perimenopause, the longer her GSM symptoms may last, possibly for 11.8 years in total,” said Dr. Lamvu. GSM is considered to be chronic, progressive, and unlikely to resolve without treatment—this, on top of its ...