Do i have PGAD?

[Dianclaude]

I'm a virgin and i have been feeling a tingling and some mild throbbing, mainly in my left vagina. This has been happening for 2 weeks. I don't experience orgasms or any burning sensation. I'm not sure if this is sexual arousal, but it started after i washed my vagina after masturbating, when it was still throbbing from the climax. The water was cold and then my vagina felt some kind of shock. It hasn't stopped since then. What is this? Please help i'm really scared of PGAD.

[Violet M]

Tingling and throbbing isn't necessarily PGAD unless it feels like sexual arousal to you. It's hard to see how a shock of cold water could be the primary cause though. It could be a trigger but I think most likely there would be some more significant underlying cause so maybe it would be a good idea to get it checked out by your physician and request a referral to a pelvic floor physical therapist, especially one who is trained in treating people with pudendal neuralgia.

For some immediate relief you could try extra strength vagisil and gel ice packs. You can get soft packs in the shape of a pad at Walgreens. You could also try inserting frozen ice balloons if it's keeping you awake at night.

Violet

[Aristocat]

Hallo Dianclaude,

Perhaps you have read my post "Another View of PGAD" and my conversation with another member of this forum, "nonsequitur".
We are both of the oppinion that most of the here discussed diseases are psychosomatic diseases.
I am not allowed to write about pudendus neuralgia but I am able to say a lot about PGAD because my deep experiences and much literature have teached me a lot.

PGAD can start in very different forms and the reasons are also as different as human beings are. I want to tell you, PGAD doesn't only mean to have oragsms we can't control anymore. Yes, there are cases with these symptoms but I am sure, this is not the greatest part of the patients.

Perhaps you have a look at the homepage from Dr. Echenberg http://www.instituteforwomeninpain.org/. He is researching in PGAD for decades and he is one of the few physicians who knows that trauma is a great reason of this disease. If I remember in a right way he writes that he had to learn that there is a fine line between sexuality and pain; and he says something quite right: PGAD is not a sexual disease but a pain disease; and out of my sight I say it is a psychosomatic disease.

If somehow possible try to stay calm. If it should be PGAD ??? inner panic will make the symptoms worse.

I do not know how a pelvic floor therapist works, in case of PGAD I only can say, exercise your attention not to tense the pelvic floor, relax it as much as you can. There are neuronal connections from the pelvic floor to the brain so in the case of tension these ways are activated. It is well known that during intercourse or masturbation to tighten the pelvic floor helps to reach orgasms. That is what we do not want.

As long as you do not know exactly what is happening to you I ask you not to masturbate. Nearly all patients are telling that sexuality does not bring relief and takes away the unpleasant feelings but makes things worse.

You should try the pieces of advise from Violet but I still want to explain that these possibilities come from trauma research. They set a counterpoint against the highly irritated autonomous nervous system.

I hope it is just an irritation and send you warm greetings from Germany.

Aristocat

[Violet M]

PGAD is not a sexual disease but a pain disease; and out of my sight I say it is a psychosomatic disease.

This may be true for some people but for the people I know who have, or who had PGAD, it is not a pscyhosomatic disease but rather it has been due to nerve damage. Trauma to the nerve causing nerve damage is what caused it in my case. There is one study that suggests tarlov cysts as a possible cause. https://www.ncbi.nlm.nih.gov/pubmed/22594432

Violet

[stephanies]

Aristocrat,

You seem to be implying that Dr. Echenberg says that PGAD is a psychosomatic condition arising from trauma. Can you please link to confirm this? I believe PGAD and pain in the other areas innervated by the PN to be primarily a result of nerve irritation, althought if PN and/or PGAD were psychosomatic conditions for you, then clearly that cause should be explored as well.

Stephanies

[Aristocat]

Today, a woman in the German Forum referred to the book "A Headache in the Pelvis" from David Wise. In the preview of the "kindle" version from amazon you can already read something about the attitude and view of the two authors. Since I can not find the book under "Publications", it might be interesting for some readers here.
The woman writes that it is not a quick training. It lasted two years until she was pain free. Now she is learnig sitting without pain. Step by step she is living without pain.

Violet and Sterphanies, of course I will answer, I only need a little more time for the translation.

To All a good new year with more solutions and a deeper understanding of our pain.

Aristocat

[Violet M]

Aristocat,

Thank you for posting this information. In the past we have had many discussions about the book by Dr. Wise. I guess it became a little less popular because some people weren't having good results but as with most therapies, it may help some people but not others.

Violet

[nonsequitur]

Violet, Stephanie,

I think there is a misunderstanding of what a mindbody syndrome is. A mindbody syndrome is not some psychological deficiency or feebleness. It is not imagined. The pain is not made up. We all suffer from mindbody syndromes all the time. Stomach problems when we travel. A tension headache after a long meeting. Those are all mindbody syndromes.

A mindbody syndrome hurts and it originates from the body but it is processed by the brain.

I have been pain free for more than 2 years now but I am not cured. I have a pain free life but If I get complacent, the pudendal neuralgia pain comes back. The pain can be as bad as it ever was. I can make it go away quickly however. Same if I take a zolpidem (Ambien) sleeping pill. I am guaranteed to have 2-3 days of pudendal pain afterward.

In the past, stretching made me feel better. PT made me feel better. Pudendal nerve blocks made me temporarily pain free.

Pudendal Neuralgia is a reality. Pelvic floor dysfunction is a reality. I had both. Among other diagnostics, I was diagnosed by imaging A 3T-MRI and an MRN. The MRN did not lie. My right pudendal nerve was visibly irritated and enlarged. Patients that have pudendal pain due to a mindbody syndrome have pudendal neuralgia.

But what maintains the pelvic floor in a state of constant contraction? It is the brain.

It is a psychosomatic syndrome. soma = body. Brain and body.

Our memories of the past have two components, explicit memory (which consists of our memory of the actual events that happened) and implicit memory (which consists of our emotional response to those events). It is our emotional (implicit) memory that acts to trigger the fight/flight and pain pathways.

The processes of the brain that create pain are unconscious and outside of our control. Thus, we can have a perfect understanding of the fact that pain is in an output of the brain, but be powerless to stop that output.

Dr. Echenberg indeed writes at length on his web site about mindbody. He has a section on the neuro-matrix theory (pure mindbody) and has a link to the brainfact.org website.

http://www.instituteforwomeninpain.com/ ... connection

But then his website is a bit all over the place so there is no way to really tell what Dr. Echenberg's deep beliefs are.
You can't blame him. Bringing up psychosomatic or conversion disorders as an explanation for chronic pelvic pain may deter potential new patients that are convinced like I was of some physical problem that needed to be fixed.

[Violet M]

When it comes to mindbody issues I just tell people to go read your posts, Ezer. I don't even begin to hope to explain it as well as you do.

But what maintains the pelvic floor in a state of constant contraction? It is the brain.

I think for some people it can be a combination of the nerves and the brain keeping the pelvic floor in a state of constant contraction. I never did the mindbody work that you have done, but my pain is gone most of the time now and is purely related to activity when it comes back. On those few occasions when it returns, it is mild, doesn't last very long, and I can trace it to activity. It seems like the brain can perceive the messages it receives from the peripheral nerves via the spinal cord or it can create it's own signals independent of the signals it receives from the peripheral nerves.

Violet

[nonsequitur]

Violet,

I understand. For me what brings back pain are psychotropic medications (Ambien for example or I had a rebound after I took a short course of opioid pain medication after a dental procedure**). Also not so much stress but more negative thinking. That negative and obsessive chatter.

My point really was to bring attention to the fact that there is no way to discard a mindbody syndrome based on the physical findings of a physician or PT. Pelvic pain due to to mindbody implies pelvic floor dysfunction. It involves changes in the body.

In other words, I want to warn patients that think "mindbody cannot apply to me because I was pain free after a nerve block", or "I don't have a mindbody syndrome because I was diagnosed with pelvic floor dysfunction", or "it cannot be me because I have been diagnosed with pudendal neuralgia" that their logic is flawed.

If the pain started during or shortly after a stressful period accompanied by a small incident/accident that triggers the pain loop, or you have a concomitant diagnosis like IBS or fibromyalgia, those are strong telltales pointing to a mindbody syndrome.

If you have a mindbody syndrome, your body will be affected. your pelvis will be tight, and the pudendal nerve will be compressed and painful. Discharging of anxiety and/or trauma into striated muscles is a common mechanism of somatization. The remedy of course, is to learn not to avoid emotions but to feel them as physical sensations.

Stephanie Predergast and Elizabeth Rummer in their new Pelvic Pain book: Pelvic Pain explained bring up (timidly) the mindbody connection.

More and more the medical community is moving toward trating the whole patient under a biopsychosocial model of care. Basically this approach to medicine takes biological, psychological (thought, emotions, and behaviors) and social (economical and cultural) factors.

I know that Stephanie is in contact or is working with Alan Gordon, a psychologist specialized in resolving pain issues.

** In fact it made me wonder if I would have recovered while I was still on opioid medication.