PPOD Case Report 7

PPOD Syndrome Diagnoses: bilateral inguinodynia (chronic inguinal pelvic pain), metrodynia (deep suprapubic/uterine pain), vulvodynia (labia and clitoris pain), vaginodynia (vaginal pain), dyspareunia (pelvic pain with intercourse), anorgasmy (loss of ability to achieve orgasm), proctalgia (rectal pain), irritable bowel syndrome (painful alternating constipation and diarrhea), dysmenorrhea (painful and irregular menstruation).

A 32-year-old woman was seen for complaints of chronic pelvic pain of approximately 9 years duration. She stated that for no apparent reason she began to experience pain on both sides of the front of the pelvis, but distinctly more intense on the right. She noted that her pain was clearly provoked by physical activity or having sat for an extended period of time and that occasionally, after these activities, she would additionally experience discomfort in her low back. She underwent evaluations by her family doctor and her gynecologist, however no abnormalities could be identified and no specific treatment was prescribed. Over time, her pain gradually intensified and as it did she began to notice the onset of a deep cramping suprapubic pain that was felt to be emanating from the uterus, as well as, pain that had developed in the outer genital region. She described her genital pain as a sharp, stabbing, and at times, pins and needles burning type of discomfort that would radiate from the labia to the clitoris which made touch or contact of any type exquisitely painful. Intercourse had become extremely painful, with pain being experienced deep within the pelvis in the inguinal and suprapubic regions, as well as, superficially within the regions of the external genitalia. In addition, paradoxically, her painful genitalia had developed a sense of accompanying numbness and she had lost the ability to achieve orgasm. As a result of these new symptoms she again saw her gynecologist, however after further evaluation no abnormalities could be found. Despite not being able to identify any specific abnormality a hysterectomy was nonetheless recommended, however because no type of pathology could be identified the procedure was denied. Over the next year, continuing to suffer the same complaints, she also began to experience the onset of burning pain that radiated into the vagina and rectal regions. Additionally, at about this same period of time, she also began to experience alternating periods of painful constipation and diarrhea, as well as, painful and irregular menstruation. She underwent separate evaluations for these complaints, however despite extensive diagnostic evaluation no abnormalities could be identified. A PPOD syndrome examination revealed the clear presence of the mechanically induced pelvic pain and organic dysfunction syndrome. Treatment resulted in a gradual improvement of her complaints. As usually occurs during the initial phase of treatment, her symptoms were transiently aggravated (“post treatment flare“). After the first few treatments she experienced a distinct increase in her pelvic, vaginal and genital pain. However, after approximately 2 weeks of care her “post treatment flare” had significantly diminished and she was aware of a reduction in the intensity of her pelvic pain. After three weeks of treatment her pelvic and genital pain and paresthesias had significantly improved. She noted that she was able to touch the genital region without experiencing the exquisite hypersensitivity that she had previously and that normal sensory perception was returning. Furthermore, she stated that her vaginal and suprapubic pain was also becoming less intense. After several more weeks of treatment all of her complaints had completely resolved and she was able to sit for extended periods of time without experiencing accompanying pelvic or back discomfort.