PPOD Case Report 11

PPOD Syndrome Diagnoses: bilateral inguinodynia (chronic inguinal pelvic pain), dyspareunia (pelvic pain with intercourse), proctalgia (rectal pain), vulvodynia (pain in the labia and clitoris), urinary frequency, urinary urgency, urinary dribbling, stress urinary incontinence (loss of bladder control with coughing, sneezing and straining), anorgasmy (loss of ability to achieve orgasm), loss of libido (loss of sexual desire), leukorrhea (persistent vaginal discharge).

A 38-year-old woman was seen for low back and right leg pain that developed approximately one year earlier as a result of a lifting injury. At the time of her injury, pain and numbness had extended down the right leg to the foot and toes. Initial orthopedic evaluation resulted in a recommendation that she undergo spinal surgery. Desiring another opinion, she sought chiropractic treatment. Spinal manipulation initially provided some relief of her back and leg pain, however her lower extremity complaints did not completely resolve. Gradually, over the next few months, low back and right leg pain increase in its intensity. Approximately one month prior to being seen by the author, she re-aggravated her condition while lifting and provoked a return of her back and leg pain. In addition, however, intermittent left leg pain began to occur. Within hours of this re-aggravation, she experienced the onset of bilateral inguinal pelvic pain, constant sharp rectal pain and urological disturbances consisting of urinary frequency, urinary urgency, post urinary dribbling and stress urinary incontinence. Upon detailed questioning, she admitted that during the months following her re-aggravation, she became aware diminished genital sensitivity to the extent that orgasm occurred less frequently and, when possible, was of a diminished intensity. Accompanying her loss of genital sensitivity was a loss of libido. Furthermore, pelvic pain with intercourse and persistent vaginal discharge also began to occur. Shortly thereafter, sharp genital pain along with numbness and tingling developed in the labia and would frequently radiate to the clitoris, making touch or contact of any type extremely painful. She stated that there was no accompanying bowel or menstrual dysfunction. One week prior to being seen by the author, a gynecologic examination, performed because of her continuing pelvic complaints, failed to reveal any abnormal findings. As a result, she was advised to return to her gynecologist only if her symptoms should worsen. On examination however, she revealed the clear presence of the mechanically induced pelvic pain and organic dysfunction syndrome. Treatment resulted in a progressive improvement of her complaints. Following one week of care, urinary frequency, urinary urgency, dribbling and incontinence had completely resolved. Her inguinodynia, dyspareunia and proctalgia had significantly improved. Menstruation, which occurred during the course of her treatment, was somewhat more painful than usual, although no abnormalities in flow or duration had occurred. After one month of care, all remaining PPOD complaints (pelvic pain, proctalgia, leukorrhea, depressed libido, genital pain and numbness, and anorgasmy), had resolved.