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Challenge the Uncomfortable Silence



The 2024 Global Year will examine what is known about sex and gender differences in pain perception and modulation and address sex-and gender-related disparities in both the research and treatment of pain.

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Every patient you see is likely to have a pelvis.  Roughly 1/4 of women will have had some pelvic pain in the course of sport, childbirth, sex or urinating.  Men are harder to pin down for exact numbers as it gets poorly diagnosed along with back pain and prostate problems but they have pelvic pain as well.  Jane Bowering did a great job pointing out the need for health professionals to ask the difficult questions and screen for pelvic pain in her write-up following the NOI2012 extravaganza found here: Pelvic Pain: all the fun stuff.

Doing a quick screen for pelvic pain conditions is fairly easy.  Start with the original Oswestry Low Back Pain Disability Questionnaire – it has a functional and practical question about sex.[1]  Interestingly, that question was removed in 2001 and replaced with little discussion in a revised edition.[2]  From what I can track down, it was done because therapists weren’t comfortable asking the question when patients left it blank.    I don’t think the discomfort of a therapist should form the quality of the screening process.  I think we can address pelvic function with the same kindness and compassion used with CRPS, CLBP and other life changing difficulties.

It may take a variety of professionals to unravel the complex contributions to persistent pelvic pain.  It may be that you are comfortable screening for pelvic pain but have no intention of treating it.  Happily there are physiotherapists, MDs, social workers and other professionals that can be part of an interdisciplinary team for these patients.  The study and treatment of persistent pelvic pain is a growing area needing robust discussion and critical thinking. The pelvis isn’t weird and mysterious. It is merely complex, with multiple social implications and psychological/biological complications.  A good portion of the fine research on CRPS and CLBP may be just the thing we need to help these patients.

It would be grand to accept the challenge that Jane proposed back in May.  Talk to your patients, listen to the answers as you do, and listen to what they aren’t saying.  Go ahead and ask them about sex, and sitting comfort and peeing/pooping.  For more information on persistent pelvic pain and what might be done about it, check out this short article in The Pain Practitioner (PDF).

About Sandy Hilton

Sandy Hilton PhysiotherapistSandy is a physical therapist in private practice, currently in the outer reaches of Chicago, USA.  Sandy is the Director of Programming for the Section on Women’s Health of the American PT Association and is supported by the Section to bring top-notch speakers on such things as Pain Neuroscience to the conferences.  She is curious about the application of Graded Motor Imagery in pelvic pain and has been stretching the CRPS and GMI research to extreme lengths in clinical practice.


[1] Fairbank JC et al. (1980) The Oswestry low back pain disability questionnairePhysiotherapy 66(8):271-3.

 [2] Fritz JM, & Irrgang JJ (2001). A comparison of a modified Oswestry Low Back Pain Disability Questionnaire and the Quebec Back Pain Disability Scale. Physical therapy, 81 (2), 776-88 PMID: 11175676
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