A hysterectomy is the partial or total surgical removal of the uterus. This can also include the removal of the cervix, ovaries, Fallopian tubes, and other surrounding structures. It’s a common procedure for women experiencing uterine fibroids, endometriosis, and cervical or ovarian cancer. Hysterectomies are the second most frequently performed procedure for women of reproductive age in the United States. Over 600,000 hysterectomies are performed every year.

While most hysterectomies are straightforward, hysterectomy recovery can be full of surprises. Here are four surprising things that women may not expect after a hysterectomy.

1- Emotional recovery

Women can be left feeling emotionally vulnerable after a hysterectomy. They can experience feelings of sadness, loss, and grief for their loss of fertility. If a woman’s hope of conceiving has been terminated by a hysterectomy, the aftermath can be even more devastating. Often, a woman’s notion of what it means to be a woman—as a mother and desirable partner—is attached to her physiology. A hysterectomy can feel like a loss of feminine identity. It can also feel like a failure, forced menopause, or a sign of premature aging, to name just a few emotions that may resonate after surgery.

Additionally, hormonal changes after a hysterectomy can contribute to mood swings, irritability, sleeplessness, and depression. If a woman’s ovaries are removed at the same time as the uterus, the immediate onset of menopause can cause even more distinct emotional symptoms. Hormone replacement therapy, nutritional counseling, or other types of supplements and medications can ease these emotional fluctuations.

Women experience a spectrum of feelings after a hysterectomy, which should be normalized. Leaning on loved ones and other women, organized support groups, or quality therapy can go a long way in helping a woman recover emotionally from hysterectomy surgery.

Remember, it is essential for patients to seek the support they need if they are struggling. If emotional disturbances are severe, they should immediately contact their doctor.

Dr. Allyson Shrikhande and endometriosis patient

2- Sexual recovery

Some women are surprised to find their sex lives disrupted by a hysterectomy. Estrogen is a hormone that helps maintain vaginal health and sexual function and is produced by the uterus and ovaries. When the uterus and ovaries are surgically removed, the sudden drop in estrogen can bring about challenging sexual consequences. Potential side effects such as vaginal dryness, painful intercourse, difficulty orgasming, diminished sensation, and a lower libido can add additional stress to a patient in recovery.

But there are definite solutions. A good-quality vaginal lubricant can boost vaginal moisture and elasticity. Estrogen creams can assist with the hormonal changes that bring about lowered sex drive and decreased sensation. And physical therapy can help a patient regain pelvic muscle tone and strength, which can alleviate pain during intercourse or difficulty achieving orgasm.

3- Bowel and bladder function

After surgery, individuals may experience changes in bowel and bladder function such as difficulty urinating, constipation, and incontinence. These embarrassing symptoms can aggravate a woman’s emotional recovery. Pelvic floor physical therapy can diminish pain and retrain muscles in the pelvis to regain control over these basic functions.

4- Lingering pain after hysterectomy 

Women with chronic pelvic pain sometimes opt for a hysterectomy. They can be dismayed to discover that the pain is not gone. In fact, between 25-40% of women report continued pelvic pain after hysterectomy.

Consulting with a pelvic health specialist like Pelvic Rehabilitation Medicine can help ensure that surgery is indeed necessary. And if it is, then they can help alleviate postoperative pelvic pain and optimize healing.

What is the recovery time for a hysterectomy?

Hysterectomy recovery time varies depending on the type of procedure and the individual’s overall health.

  1. For a vaginal hysterectomy, patients can return to normal activities within 2-4 weeks and can return to work within 4-6 weeks.
  1. For a laparoscopic hysterectomy, patients can also return to normal activities within 2-4 weeks and can return to work within 4-6 weeks.
  1. For an abdominal hysterectomy, the recovery time is longer. Patients can return to normal activities within 4-6 weeks and can return to work within 6-8 weeks.

A hysterectomy is major surgery. Even after the recommended hysterectomy recovery time, a woman may still experience discomfort, pain, or fatigue. She should resume activities slowly and thoughtfully. Keep in mind that it’s always important to follow the recommendations provided by the surgeon and medical team.

How can a patient alleviate symptoms after a hysterectomy?

Pelvic Rehabilitation Medicine (PRM) can help with a variety of post-op problems. PRM is a physician practice with offices nationwide that offers a functional and restorative approach to persistent pelvic pain. We have experience treating the repercussions of hysterectomies, both partial and full.

Whenever possible, we use non-pharmacologic and noninvasive interventions that expose patients to less risk than invasive measures or drug therapies. One of the most important of these treatment options is pelvic floor physical therapy.

A multi-modal approach can reduce hysterectomy recovery time

If a patient is experiencing lingering physiological symptoms after a hysterectomy, our team of pelvic pain specialists can help them recover sooner.

Many of our patients come to us 6 months to several years after a hysterectomy and are still experiencing pain. We recommend that if a woman is still enduring extreme discomfort after the three-month mark, she ought to see a specialist. It is simpler to correct certain pelvic issues before they become deeply established in the body.

At PRM, we use a multimodal approach to healing persistent pelvic pain. This can include our pelvic nerve and muscle treatments, managed pelvic floor physical therapy, lifestyle modifications, and medications such as muscle relaxers.

Our unique approach is the first and only of it’s kind in the country and focuses on reversing the inflammation in the pelvic floor, resetting the nerves and muscles, and retraining the pelvic floor.

While hysterectomy recovery can be surprising and sometimes difficult to manage, women do not need to suffer. Please reach out – we can help reduce your symptoms faster and help you regain an optimal quality of life.

It’s a sad truth that endometriosis doesn’t get talked about nearly as much as it should. This often painful disorder – in which tissue similar to the uterine lining grows outside the uterus, causing bleeding, lesions, and other issues – is not particularly rare. As a matter of fact, it affects an estimated one in ten women in the United States. However, endo is often under-discussed, misunderstood, and misdiagnosed, leaving many patients with inadequate care that fails to alleviate their symptoms.

Dr. Allyson Shrikhande and Dr. Lyndsey Harper are well-versed in identifying and treating this illness. Dr. Shrikhande is a board-certified physiatrist and the chief medical officer of Pelvic Rehabilitation Medicine, a dedicated pelvic pain practice with locations in over a dozen cities nationwide. Dr. Harper is a board-certified Ob/Gyn who is also the founder and CEO of Rosy, a new app dedicated to providing community and educational resources that help women overcome sexual health issues and have better sex overall. Here is what they had to say about the key challenges and takeaways from their experience helping patients who have endometriosis.

  1. The path to diagnosing endometriosis may not always be simple and can be different for every woman. What are some indicators you look for when you suspect a patient may have endometriosis?  

Dr. Harper: If a patient has a history of painful periods, I would automatically suspect endometriosis. In some other cases, there can be histories that involve painful sex, infertility, and bowel or bladder symptoms during menses.  Any of these symptoms can be due to endometriosis, and if a patient reports more than one of these, the suspicion is even higher.

  1. Is there any specific kind of testing you administer or refer out to reach a diagnosis? 

Dr. Harper: Diagnosis of endometriosis is extremely challenging and that is a big part of the reason that it takes many women so long to get diagnosed. In some cases, endometriosis can cause cysts on the ovaries that can be seen by ultrasound, but in the vast majority of cases, a woman has to undergo laparoscopic surgery to investigate whether or not endometriosis is the cause of her symptoms. The fact that we do not yet have a reliable non-surgical test is a major frustration for many physicians and their patients. 

  1. When would you say is the right time to bring in a physiatrist/referring provider to help treat this patient?  

Dr. Harper: If a patient has persistent pain due to endometriosis (and many other causes) that is not well controlled with medication or after surgery, I would definitely start involving other providers in the plan of care. Whenever pain is involved, we want to address it in as many ways as possible in order to avoid all of the negative effects that pain can have on our body and on our mental health. 

  1. Is there any kind of supplemental testing you administer/perform that could be different from an OB/GYN to help solidify a diagnosis? 

Dr. Shrikhande: Pelvic floor spasm symptoms often overlap with endometriosis symptoms – these include pain with/post intercourse, constipation, abdominal bloating, abdominal pain, and urinary urgency, frequency, or pain with urination. Therefore the best tool that we have to diagnose endometriosis is a thoughtful history looking for specific details such as onset of pain, family history, autoimmune disease, and infertility.

  1. As a physiatrist, what is your treatment protocol when treating a patient with endometriosis?

Dr. Shrikhande: As endometriosis is a systemic inflammatory disease process, we take a holistic approach. Endometriosis often upregulates the nervous system and causes chronic pelvic floor muscle guarding. Therefore, we use modalities which address the nerve inflammation and muscle spasms. These often include pelvic floor physical therapy, muscle relaxer suppositories, mindfulness/meditation, and a series of external ultrasound guided peripheral nerve blocks with trigger point injections to the pelvic floor. 

Sometimes, depending on the severity and chronicity of the patient, we will use an oral medication to treat the central nervous system. Together, this multimodal outpatient treatment protocol works to reset and retrain the nerves and the muscles to a more calm state with less inflammation and more blood flow. We also focus on nutrition, optimizing bladder and bowel function, as well as exercise and sleep.

  1. How do you both consistently work together on the path to helping the patient find relief?

Dr. Harper:  In my experience, communication is key. This is important between the patient and all providers taking care of her. One of us may have one understanding of the issue and processes involved, while the others of us can add our own experience and expertise. When there is open communication among all involved, the best outcomes are achieved for the patient.  

Dr. Shrikhande: Physiatry and gynecology use a team approach to treating Endometriosis. Typically a GYN is in charge of the initial work up for a patient’s pelvic pain symptoms: imaging, cultures, blood work, etc. A GYN is an expert in the female organs and is essential to the process, particularly for the surgical excision of endometriosis. A GYN is also extremely knowledgeable about the hormonal aspect of endometriosis and can recommend hormonal treatments. 

A pelvic physiatrist is an expert on diagnosing and treating nerve and muscle pain and inflammation that comes with endometriosis. The nerve and muscle dysfunction are directly related to a patient’s symptoms of pelvic pain, as healthy pelvic nerves and muscles are required to have pain-free intercourse and healthy bladder and bowel function.


To learn more about Rosy, visit their website here: https://meetrosy.com/

You can download the Rosy app here:

Our Chief Medical Officer, Dr. Allyson Shrikhande discusses pelvic floor physical therapy with Dr. Laura Meihofer PT, DPT, ATC, RYT 200 and how it is a critical part of the PRM treatment plan for helping patients find relief.

To learn more about Dr. Laura Meihofer, visit her website: https://laurameihofer.com/

Follow her on social channels:
Instagram: https://www.instagram.com/laurameihofer/
Facebook: https://www.facebook.com/laurameihofer/
LinkedIn: https://www.linkedin.com/in/laura-meihofer
YouTube: https://www.youtube.com/channel/UCcTgM_qYmkZVMS1548I7eFA

Title:  Working with Physiatry for Pelvic Pain Webinar

Date: Monday, September 13th

Time: 7 p.m. to 8 p.m. EST

Price: $35. Receive 1 CE credit.

About: This course overviews the core elements, including diagnosis and non-operative treatment options, for a successful pelvic floor physical therapy and pelvic physiatry relationship for non-operative management of men and women with Chronic Pelvic Pain (CPPS). This course aims to describe the synergistic nature of pelvic physiatry with pelvic floor physical therapy, in hopes of promoting collaboration for the care of male and female chronic pelvic pain patients.

Registration: Click the link below to register

Pelvic Pain Doesn’t Have to be a Life Sentence with Dr. Anna Cabeca and Dr. Allyson Shrikande, Dr. Rucha Kapadia.

Dr. Anna Cabeca visits the Pelvic Rehabilitation Medicine center to talk with Dr. Allyson Shrikande and Dr. Rucha Kapadia about pelvic pain. Find out why it’s so hard for pelvic pain to be diagnosed properly, especially after childbirth, what you can do to help relieve pelvic pain during intercourse, and how pelvic floor exercises and therapy can prevent a lifetime of discomfort and pain.

Resources mentioned in this Episode:


In this episode, we discuss pelvic health from the lens of physiatry with Dr. Allyson Shrikhande, MD. She is the medical director and founder of Pelvic Rehabilitation Medicine (PMR), offering true multidisciplinary care for people with pelvic floor dysfunction.

Allyson shares what a pelvic health physiatrist does, saying “we’re trained really to look at the interplay between the organ systems with each other, as well as the organ systems with the fascia, the muscles, and the nervous system.” Physiatrists can serve as the quarterback for people with pelvic floor dysfunction, referring them to the various specialties. She also shares how all of us pelvic providers can work together and how the mind-body connection affects pelvic pain

Learn more about The Conscious Clinician Podcast by going here.

In episode 76 of Fibromyalgia Real Solutions, Amanda Love and Dr. Shrikhande discuss: Pelvic Rehabilitation Medicine and what it means, pelvic pain, fibromyalgia, and more.

Learn more about Amanda Love by going to her website.

Advanced Urology’s Dr. Marc Greenstein and Pelvic Rehabilitation Medicine’s Dr. Yogita Tailor discuss pelvic floor injections for pelvic pain in this webinar.

Dr. Marc Greenstein specializes in all aspects of Urology including kidney stones, men’s health, female and male pelvic pain syndromes, interstitial cystitis, urologic cancers and minimally invasive procedures.

He treats his patients with a holistic, integrative approach. Learn more about Dr. Marc Greenstein by visiting the Advanced Urology website.

In Episode 25, Erin Everett, NP-C, interviews Dr. Allyson Shrikhande,  Chief Medical Officer at Pelvic Rehabilitation Medicine about her patient centered approach to treating common post-op pelvic floor pain after gender affirming surgeries. Topics include interstitial cystitis, vaginismus, pain with intercourse, endometriosis and PCOS, and chronic prostatitis.

Learn more  about Erin Everett, NP-C by going to her website.

Dr. Allyson Shrikhande had a blog published in Rosy discussing Pelvic Pain Gender Affirmation Surgery.


What is gender affirmation surgery?

Gender affirmation surgery is a surgery for transgender individuals with a goal of alleviating gender dysphoria by providing the physical appearance and functional abilities which match their inner self. While this is a medically necessary procedure for many who are trans, it also significantly changes the anatomy of the pelvic region and can cause pain and a range of other side effects. It is typical to feel some pain or discomfort immediately after major surgery, but pain that does not subside or even worsens over time is not normal and should be treated.

How can gender affirmation surgery affect the pelvic floor?

Bottom surgery can have a major impact on the structures of the pelvic floor. Invasive surgery and other trauma to the area can cause the pelvic floor muscles to shorten, resulting in weakness and spasticity. Surgery can also cause the formation of scar tissue and pelvic adhesions which may affect blood flow and exacerbate pain.

To learn more about Rosy, visit their website at: https://meetrosy.com

Read the full blog here.

Title:  Emory Sports Medicine Center Virtual Women’s Sports & Wellness Conference

Date: Saturday, August 7, 2021

Time: 8 a.m. – 3 p.m. EST

Price: Physicians, Physician Assistants, Physical Therapists, Athletic Trainers, Allied Professionals (CEUs): $40 *you will also receive CME credits; Community Members: $10 *No CME credits will be awarded

About: This year the event will be virtual and we will have sessions all throughout the day. You will be able to participate in as little or as many sessions as you wish. We are looking forward to seeing you there.

Our 2021 conference features health care experts to discuss current and relevant topics relating to the health and wellness of female athletes of all levels and generations. As women and young girls continue to dominate the world of sport, we must recognize the impact sports and fitness can have on the female body. This difference has led to innovative research that studies how high endurance and consistent low impact performance can affect a woman’s body from adolescence to young adulthood, to motherhood, and peaking as a senior athlete.

The Women’s Sports & Wellness Conference seeks to provide an opportunity to bridge this research and the resulting contemporary solutions and strategies geared toward prevention, treatment, and rehabilitation with the female athlete in mind. The conference will provide attendees with knowledge and advice in navigating significant real-life issues for the contemporary athlete with topics ranging from nutritional trends, psychological impacts, and the woman’s changing body (adolescent, pregnancy, and aging.) Also, medical experts will provide new information on the cutting-edge technologies and treatments used at Emory Healthcare and nationally, all while providing networking opportunities with colleagues and thought leaders in the field.

Who Should Attend?:

Community Athletes:
  1. Female athletes
  2. Weekend warriors
  3. Senior athletes
  4. Fitness moms
  5. Expecting (or soon to be) athletes
  6. Parents of young athletic girls (along with young athletes)
  7. Adolescent athletes
  8. Coaches
Healthcare Professionals:
(Educational credits available):
  1. Physicians
  2. Coaches
  3. Physical therapists
  4. Athletic trainers
  5. Nutritionists
  6. Psychologists

Registration: Click the link below to register

Dr. Allyson Shrikhande speaks with Herman & Wallace Pelvic Rehabilitation Institute about Physiatry

Excerpt from the interview:

Q: What is a physiatrist?

A: A physiatrist is an MD or DO with a specialty in Physical Medicine and Rehabilitation. This non-operative medical discipline involves focusing on the neuromusculoskeletal system to help patients recover their functional well-being and quality of life. We describe physiatry as an extension of physical therapy because a physiatrist diagnoses, manages, and treats pain from injury, illness, or medical conditions, incorporating other methods in concert with physical therapy to rehabilitate the body. Physiatrists are trained not solely in one organ system – rather, they take a holistic, full-body approach that accounts for the interplay of different organ systems, both with each other and with the neuromuscular and myofascial systems.

Q: What does a physiatrist do? 

A: Physiatrists work with physical therapy to rehabilitate the neuromuscular system. A core underlying theme in physiatry is the concept of Neuroplasticity. This is the understanding that the nervous system has the ability to form and reorganize synaptic connections, especially in response to experience or learning following injury.

Read the full interview here.

Join Dr. Carolyn Moyers as she chats with Dr. Rucha Kapadia, physical medicine and rehabilitation (PM&R) specialist at Pelvic Rehabilitation in Dallas. She is a pelvic pain specialist with experience in treating both male and female patients who experience chronic pelvic pain, core muscular and pelvic floor dysfunction, and musculoskeletal-related issues.

It’s exciting to know there are a variety of options for the treatment of pelvic pain. The answer isn’t always surgical.

Learn more about Dr. Moyers by going to her website: https://skywomenshealth.com

Dr. Allyson Shrikhande had a blog published in Rosy discussing Chronic Pelvic Pain Syndrome (CPPS).


Why is CPPS so difficult to diagnose?

CPPS is a complex condition which often involves multiple organs as well as the nervous, myofascial, and skeletal systems. Some of the most prevalent risk factors for CPPS, such as endometriosis or neuromuscular dysfunction, are very challenging to diagnose as the issue may not always be apparent on x-rays, ultrasounds or other common imaging tests. It takes a specialist in pelvic pain making informed analysis based on a patient’s medical history and symptoms to properly identify CPPS.

How does CPPS affect a woman’s sex life?

CPPS can have devastating affects on a patient’s sex life. It can cause pain during intercourse which ranges from a superficial burning sensation to pain with deep penetration. This pain may occur every time penetration occurs, or just in certain positions. CPPS can also cause post-intercourse pain, soreness, or bladder symptoms. For some patients, the pain is so severe that they stop having intercourse altogether.

To learn more about Rosy, visit their website at: https://meetrosy.com

Read the full blog here.

Dr. Allyson Shrikhande had a blog published in Rosy discussing the effects of stress on pelvic pain.


April is Stress Awareness Month, although I’m going to go out on a limb and say stress is something that we’ve all been pretty keenly aware of for most of the past year. Stress and anxiety are fully understandable responses to the way that 2020 and the start of 2021 have unfolded, but that doesn’t change how unpleasant they can be, or the negative impact that these feelings can have on your health.

It’s important to have strategies in place for coping with stress not only for the sake of your mood and emotional state, but also because of the very real relationship that that stress has with your physical health. This is particularly true of people with chronic pain issues. Emotional duress and physical pain very frequently go hand in hand, and it’s critical to treat both sides of this equation.

To learn more about Rosy, visit their website at: https://meetrosy.com

Read the full blog here.


What do you do and who do you see when you feel like you have a UTI… but you don’t? You might feel like you have to pee all the time and it might even cause you a burning pain. You’ve been given antibiotics, dose after dose. You’ve been told to do a million kegels… but you are back to square one.

Today we sit down with the brilliant Dr. Allyson Shrikhande, a board certified Physical Medicine and Rehabilitation specialist and the Chief Medical Officer of Pelvic Rehabilitation Medicine. We discuss bladder pain syndrome, often called Interstitial Cystitis, it’s symptoms, diagnosis, and treatment plan. Dr. Shrikhande advocates for a holistic approach to medicine where the patient is evaluated for more than just the single organ that seems to be an issue. Especially when it comes to pelvic-related problems, there can be multiple components that might be causing pain.

Learn more about Dr. Sneha Gazi by going to her website:

This course is for Pelvic Floor Physical Therapists that would like to continue their education.

CEU Credits will be obtained

Title: Working with Physiatry for Pelvic Pain – Remote Learning Course

Date: Jun 27, 2021

Time: 1:00 pm – 3:00 pm EST

Price: $120

Experience Level: Beginner

Contact Hours: 4

Instructor: Dr. Allyson Shrikhande & Dr. Tayyaba Ahmed

Course Overview: This course overviews the core elements, including diagnosis and non-operative treatment options, for a successful pelvic floor physical therapy and pelvic physiatry relationship for non-operative management of men and women with Chronic Pelvic Pain (CPPS). This course aims to describe the synergistic nature of pelvic physiatry with pelvic floor physical therapy, in hopes of promoting collaboration for the care of male and female chronic pelvic pain patients.

Upon completion of this program, participants will be able to:

  • Describe the Pathophysiology of Chronic Pelvic Pain Syndrome (CPPS)
  • Understand the Physiatrist approach to the problem
  • Identify non-operative Pelvic Physiatry Treatment options available, in addition to Pelvic Floor PT

Dr. Allyson Shrikhande had a blog published in Rosy discussing endometriosis.


March is Endometriosis Awareness Month, dedicated to shining a spotlight on a serious chronic illness that affects one in ten women in the United States. While endometriosis has been gaining in visibility over recent years, with more organizations emerging to promote awareness and some celebrities like Chrissy Teigen and Padma Lakshmi coming forward to share their personal experiences with endo, we still have a long way to go in building a greater understanding of this disorder among patients and healthcare providers alike. It’s so important to recognize the very real impact that this invisible illness has on people’s lives and promote awareness of the ways that it can be treated.

To learn more about Rosy, visit their website at: https://meetrosy.com

Dr. Shrikhande had a blog published in Rosy discussing pudendal neuralgia.

The pelvis is a massively important part of the body, involving a complex interplay between muscles, joints, and nerves. When any part of the whole is not functioning properly, it can cause serious pain and impede your ability to enjoy sex or even get through basic day-to-day activities. The problem can be compounded when the source of the issue is difficult to talk about or not immediately evident. One relatively rare, but chronically under-discussed cause of pelvic pain is pudendal neuralgia (PN).

What Is the Pudendal Nerve?

The pudendal nerve is a major nerve located in the pelvis. It spans from the rear portion of the pelvis to the base of the penis or vagina. It is highly important to sexual function, being the component of the nervous system that relays pleasure signals from the outer genitalia to the brain. It also does some work on the back end (so to speak), being responsible for the opening and closing of the sphincter while using the toilet.

To learn more about Rosy, visit their website at: https://meetrosy.com

Here is a description of that show:

Dr. Allyson Shrikhande speaks with Patricia Ladis PT, CBBA, founder of Wise Body PT and author of Wise Woman’s Guide to Your Healthiest Pregnancy & Birth about pelvic health.

Learn more about Patricia Ladis by visiting her website: https://www.patricialadis.com/

Instagram – https://www.instagram.com/patricialadis/

More information on her book – https://www.patricialadis.com/wise-woman-s-guide

Here is a description of that show:

Many women are living with symptoms of pelvic pain and dyspareunia (pain with sex). There are many reasons associated with these symptoms, as well as many therapy options. Tune in to hear Dr. Marjorie Mamsaang, a trained Doctor of Osteopathic Medicine as she breaks down all you need to know about pelvic pain and dyspareunia.

To learn more about Shalonna Battle please visit:

Here is a description of that show:

In this episode, we talk to Dr. Allyson Shrikhande, a board-certified Physical Medicine and Rehabilitation specialist and the Chief Medical Officer of Pelvic Rehabilitation Medicine. She is also the Chair of the Medical Education Committee for the International Pelvic Pain Society.

We talk about pelvic physical therapy, pelvic therapy as well as endo pain, and some tactics to help reduce the pain and inflammation.

A reminder this podcast is not to replace treatment, always talk to your doctor. The views expressed on the show may not reflect the views and opinions of the cycle podcast.

Want to watch it on YouTube?


Thank you for listening and supporting this podcast. We need awareness about this disease.

If you want to be on the podcast or have feedback please reach out via my website.


Thank you for your support and time. Please consider subscribing and writing us a review on Apple podcasts it really helps us get more awareness and with guests agreeing to come on!

Here is a description of that show:

Paul Gagliano, PT, DPT, Sara Gagliano, PT, DPT, CLT-UE, Carrie Yaeger, PT, DPT, PRPC and Dr. Allyson Shrikhande, MD join together to discuss keys to early detection in a silent, but common condition affecting women of childbearing age…..endometriosis.

To learn more about the Therapist in Motion podcast visit:

To learn more about Spooner Physical Therapy visit:

Here is a description of that show:

Our guest is Dr. Carolyn Thompson Chudy, DO. Dr. Carolyn is a Physiatrist who is board certified in Physical Medicine and Rehabilitation and fellowship-trained in Interventional Spine and Sports Medicine. Her specialties include non-operative management of pelvic pain, sports injuries, and spine conditions. Dr. Chudy received her undergraduate degree from the University of California, Berkeley before attending medical school at Western University of Health Sciences. She completed her residency at New York-Presbyterian – Cornell and Columbia and pursued a subspecialty fellowship in Interventional Spine and Sports Medicine at Columbia University. During her fellowship, she developed a strong interest in the use of ultrasound for both accurate diagnosis and targeted treatment. Dr. Carolyn Chudy uses a comprehensive, holistic approach to treatment, using every non-invasive tool to help her patients avoid surgery.

What will you learn:

  • Carolyn’s story and career
  • Treatment of pelvic disorder
  • The relationship between the doctor and the physical therapist
  • The best care for patients
  • Working as a team
  • Advice to clinicians that are starting their careers
  • How to become successful in Physical Therapy

Website: https://www.pelvicpain.org/
Instagram: https://www.instagram.com/ptprotalk/
Facebook: https://www.facebook.com/ptprotalk
LinkedIn: https://www.linkedin.com/company/pt-pro-talk
Email: mariana@ptprotalk.com

Dr. Shrikhande had a blog published in Rosy discussing painful sex after a hysterectomy.

Painful sex can be a difficult thing to talk about. The millions of women who experience pain during intercourse, or dyspareunia, can have feelings of frustration and embarrassment. It can be particularly frightening for those who experience these symptoms after undergoing a total hysterectomy. Surgical removal of the uterus is sometimes a necessary procedure – hysterectomies are the second-most common surgery for women – but the post-surgery effect on the body can be distressing and disorienting.

While painful sex in the aftermath of a hysterectomy is not entirely uncommon, it is also not something that should be ignored. Some pain and discomfort while recovering from surgery is to be expected, but debilitating pain that prevents you from having a fulfilling and enjoyable sex life is a medical issue. It’s important to know what to expect from sex after your procedure, and to be aware of the signs that something is wrong.

To learn more about Rosy, visit their website at meetrosy.com


To read the full article click HERE.

Here is a description of that show:

Men Feel It Too: The Scoop On Male Pelvic Pain

About 10% of males in the US experience some form of pelvic pain. Nonbacterial Prostatitis tends to be one of the most common diagnoses. However, many men are seen by multiple urologists, receive extensive medical work up, find that none of the medications works, and end up feeling helpless. When they are finally seen by a pelvic specialist, they can begin to have the confidence they need to regain control of their life.

Dr. T. R. Christian Reutter from Pelvic Rehabilitation, explains to us why seeing a pelvic pain specialist should be the first line of defense in the absence of bacterial/viral infection. Other than being set up with pelvic floor physical therapy, specific medications, trigger point injections, peripheral nerve hydrodissection injections, and other minimally invasive procedures can help men who experience pelvic pain.

Dr. Reutter attended medical school at the University of Health Sciences College of Osteopathic Medicine in Kansas City Missouri and then completed his residency in Physical Medicine and Rehabilitation at the University of Texas Health Science Center in San Antonio, Texas. He practiced for almost 17 years as a sports medicine and spine specialist in San Francisco, California before joining the Pelvic Rehabilitation Medicine team in New York.

He took an interest in pelvic pain and realized that there were limited resources with regard to addressing pelvic pain conditions. He joined the Pelvic Rehabilitation Medicine Team in order to further pursue his interests.  As a physiatrist, he feels that he brings a unique approach to patient care with the goal of pain reduction/resolution, improvement in the quality of life, and allowing the patient to return to the activities that they enjoy.

Learn more about Dr. Sneha Gazi by going to her website:



Here is a description of that show:

Paul Gagliano, PT, DPT, Sara Gagliano, PT, DPT, CLT-UE and Dan Miriovsky, PT, DPT, OCS, FAFS, ATC are joined by Dr. Allyson Shrikhande, MD of Pelvic Rehabilitation Medicine. The four discuss the importance of an integrated care team and the role of managing pelvic floor issues.

To learn more about the Therapist in Motion podcast visit:

To learn more about Spooner Physical Therapy visit:


Endometriosis is the abnormal growth of uterine tissue outside the uterine cavity that can cause chronic pain, dysmenorrhea, and dyspareunia. Although the disease is common and nonmalignant in nature, the symptoms can severely impact function and quality of life. Treatment options for endometriosis are limited and not well understood despite a growing need.


Research is done by: Dr. Allyson Shrikhande, Dr. Tayyaba AhmedDr. Charity Hill

Read the full article here.



Urological chronic pelvic pain syndrome (UCPPS) represents a group of pain symptoms relating to patients with pelvic pain for which treatment is largely unsatisfactory. The objective of this study is to analyze the effects of a novel treatment strategy in males suffering from UCPPS.


Research is done by: Dr. Allyson Shrikhande, Dr. Gautam Shrikhande, Dr. Tayyaba Ahmed, Dr. Christian Reutter, Dr. Charity Hill

Read the full article here.


Here is a description of that show:

Dr. Ramchandani has a conversation with Dr. Chudy about Pelvic Pain.  She is a physiatrist located in New York and works with Pelvic Rehabilitation Medicine.

To learn more about Dr. Ramchandani, visit his website at:

To listen to more of The Physiatry Podcast, go here:

Estimates reveal that anywhere from 11-40% of adults in the U.S. have chronic pain, which is linked to disability, opioid addiction, anxiety, depression, and increased medical costs. More specifically, chronic pelvic pain affects up to nearly a quarter of all women worldwide.

Dr. Jana Scrivani, a clinical psychologist specializing in pelvic pain, joins us for a lively conversation today to answer the question – “What is Pain?” She discusses how pain is real and is mediated by the brain by various pathways in the nervous system. Dr. Scrivani created a behavioral health program for Pelvic Rehabilitation Medicine called Retrain Your Brain where she guides clients through virtual group sessions to understand their pain. Her goal is to empower her patients to help them change the way they act, think and approach their bodies.

Learn more about Dr. Sneha Gazi by going to her website:

Call 713-487-1580 to set up a 10-min free consultation to see if the Retrain Your Brain Course is right for you.


Dr. Allyson Shrikhande had a blog published in Rosy discussing PGAD.

Sexual pleasure under appropriate circumstances is normal and natural, something that we should be able to talk about openly without shame or stigma. However, for some, feelings of sexual arousal may be constant and intense, occurring in unwanted situations. For these people, this can be embarrassing, uncomfortable, and even painful. This is known as Persistent Genital Arousal Disorder, or PGAD. It’s a real medical condition with real medical causes, and its symptoms are not normal, but they can be treated.

What is Persistent Genital Arousal Disorder?

Persistent Genital Arousal Disorder, also known as restless genital syndrome or persistent sexual arousal syndrome, is a condition that causes uncontrollable, unwanted spontaneous sexual arousal without any sexual stimulation with or without orgasm. While most common in women, it can also affect males. Persistent arousal can last days and even weeks, causing pain, discomfort, and disruptions in your day to day life.

What are the symptoms of PGAD?

The disorder is generally marked by ongoing feelings of sexual arousal that become uncomfortable and disruptive. In women, this can involve unprompted swelling of the clitoris and labia, as well as wetness, itching, and burning. Men with PGAD often report penile pain or erections that do not go away even after several hours. When symptoms first emerge, the disorder is often mistaken for a urinary tract infection because of similar feelings of itching and burning. UTIs, if untreated, can also cause Persistent Genital Arousal Disorder symptoms.

To learn more about Rosy, visit their website at: https://meetrosy.com/
Read the full blog here.

Here is a description of that show:

Meet Dr. Melanie Howell, a board certified physiatrist practicing in the area of pelvic health. Dr. Howell shares why she began practicing this specialty, what a physiatrist is, as well as some treatment interventions she utilizes for chronic pelvic pain. Dr. Howell can be found at www.pelvicrehabilitation.com under the location tab for Englewood, NJ.

Here is a description of that show:

In this episode, I had the pleasure of sitting down with Dr. Melanie Howell, a pelvic pain specialist from Pelvic Rehabilitation Medicine. We talk about a few things including how physiatry is similar and different to physical therapy, common conditions treated, endometriosis, and even male pelvic health.

Dr. Howell received her medical degree from the University of Medicine and Dentistry-School of Osteopathic Medicine.  She then completed a residency in Physical Medicine and Rehabilitation from NYU Langone Medical Center, where she received hands-on training in the treatment of pelvic pain in both men and women.  Upon completion of her residency, she went on to pursue fellowship training in Cancer Rehabilitation Medicine at Memorial Sloan Kettering Cancer Center. Dr. Howell is board-certified by the American Board of Physical Medicine and Rehabilitation. She joined Pelvic Rehabilitation Medicine as a pelvic pain specialist in June 2019.


We published a manuscript entitled “A Novel, Non-opioid Treatment for Chronic Pelvic Pain in Women with Previously Treated Endometriosis Utilizing Pelvic-Floor Musculature Trigger-Point Injections and Peripheral Nerve Hydrodissection”. There is little consensus in the literature on the underlying etiology of endometriosis. There is even less evidence on effective treatment options for endometriosis and its associated chronic pelvic pain. Although there is no cure, traditionally endometriosis symptoms are managed with a combination of hormonal and surgical treatments. This manuscript is a commentary on a unique outpatient neuromusculoskeletal protocol to add to the traditional hormonal and surgical approaches to help improve pain and function in patients with endometriosis. This commentary takes a gastrointestinal and colorectal slant as to how the complex disease process of endometriosis can affect these organ systems and the symptoms that arise when this happens.

Research done by: Dr. Allyson Shrikhande 

Read the full article here.


Chronic pelvic pain (CPP) is one of the most common pain conditions suffered by women and can severely affect the quality of life, including physical functioning, psychological wellbeing, and interpersonal relationships. The estimated prevalence for women of reproductive ages is between 14% – 24%, and about 14% of women experience CPP during their life [1,2]. CPP syndrome in women is multi-faceted with interconnections between organ systems, musculature, fascia, and the peripheral and central nervous system. Standard treatments often have limited effectiveness. To date, there is a broad range of complementary and alternative medicine (CAM) techniques that have been studied for the treatment of CPP. Therefore, it is essential for providers to be familiar with a range of treatment options that draw from conventional medicine, as well as complementary and alternative modalities.

Research done by: Dr. Jana Scrivani & Dr. Allyson Shrikhande 

Read the full article here.

Background: This study was performed to evaluate the effectiveness of treatment of women with Chronic Pelvic Pain Syndrome (CPPS) using a combination of external ultrasound-guided trigger point injections to the pelvic floor musculature with peripheral nerve hydrodissection.

Methods: A retrospective study of 73 women with CPPS who were treated with external ultrasound-guided trigger point injections to the pelvic floor musculature with pelvic peripheral nerve hydrodissection once a week for six weeks in an outpatient setting. Pelvic pain intensity as measured pretreatment and post treatment using the Visual Analogue Scale and Functional Pelvic Pain Scale. Categories of function evaluated were bladder, bowel, intercourse, walking, sleeping, working, running, and lifting.

Conclusion: Analysis suggests that the treatment was effective at ameliorating pain in women with CPPS. It showed promise in improving overall pelvic function in women with CPPS, specifically in the categories of intercourse and working.

Research done by: Dr. Allyson Shrikhande

Read the full article here.

Here is a description of that show:

Dr. Allyson Shrikhande M.D., a board-certified Physical Medicine and Rehabilitation (PM&R) specialist, Chief Medical Officer of Pelvic Rehabilitation Medicine, and pelvic pain expert talks to us about changes that happen in the pelvic floor postpartum and how PM&R specialists can help treat pelvic pain postpartum.

To learn more about The PUSH Revolution, go to their website at:


Follow them on their socials:

Instagram – https://www.instagram.com/postpartum.push/

Facebook – https://www.facebook.com/thepushrevolution/

An Integrative Medical Approach to Postpartum Pelvic Dysfunction with Dr. Allyson Shrikhande

Here is a description of that show:

Today I talk with Dr. Allyson Shrikhande about how to holistically to heal your pelvic floor during postpartum using a multidisciplinary approach. We talk about some of the “common but not normal” symptoms that postpartum people experience, including bladder urgency, frequency, and incontinence, painful intercourse, painful bowel movements, constipation, hemorrhoids, fissures, and UTI symptoms that won’t go away. Dr. Allyson also talks about the importance of building a team of healthcare providers postpartum, and why it’s best get in “early and often” for pelvic floor care (it’s easier to fix when it’s not a chronic problem!). We also talk about other pelvic pain conditions such as endometriosis, and what a “normal” menstrual cycle should feel like *hint – it shouldn’t be so painful that you stay home from school/work! Bottom line: know your options, build your team, put yourself first, and don’t let any physician normalize the symptoms you have!

To learn more about Annie Hopkins, visit her website:

Follow her on Instagram:
@fullbloomwellness603 and/or my personal ig is @actrick

Facebook: The Postpartum Revolution private group: https://www.facebook.com/groups/657837214948980

About Annie:

Annie Hopkins, PT, RYT is a pelvic health physical therapist and yoga instructor who lives and works in the Seacoast of New Hampshire. She developed a passion for helping pregnant and postpartum people feel more at home in their changing bodies through yoga, and completed a prenatal yoga course in 2010. Annie then deepened her knowledge about perinatal pelvic health and wellness by becoming a pelvic health PT in 2018 and is currently working towards becoming a Certified Birth Healing Specialist through the Institute of Birth Healing as well as an Ayurvedic Postpartum Doula. Through this work, she strives to empower people with knowledge and self-confidence and help guide them on their path to wholesome healing using exercise, hands on techniques, wellness information, and mindfulness practices. You already have the power inside you. I’m just here to help guide you back home to who you are.

In this episode of Beyond Postpartum, we focus on a physical aspect of postpartum recovery, but pelvic pain (or any sort of chronic pain) and dysfunction can negatively affect mental health and one’s quality of life.

Here is a description of that show:

In this episode of Beyond Postpartum I had the honour and privilege of speaking with Dr. Allyson Shrikhande who is a Physiatrist and Pelvic Rehabilitation Specialist. This episode is a bit different as it focused on a physical aspect of postpartum recovery, but pelvic pain (or any sort of chronic pain) and dysfunction can negatively affect mental health and one’s quality of life, so I am excited to bring you this conversation. Plus, variety is the spice of life, am I right?

In this episode we talk about:

  • What Physiatrists are and what they do
  • How pelvic rehab has been neglected by the medical community
  • Allyson’s experience with pain in pregnancy and postpartum – and how this was the instigator for her to specialize in pelvic rehabilitation and develop the protocol she uses
  • The rates of chronic pain and dysfunction that can occur after giving birth
  • How that 6 week mark is an important indicator of whether you should seek treatment or not
  • The connection between physical health and mental health
  • Tips to help start feeling back to normal and where to start if you are suffering with pain or dysfunction
  • The power of preventative care
  • Some potential risk factors
  • What she did to help herself get better (hint: it’s similar to what she has her clients do!)
  • Where to start in your own recovery

To learn more about Pacific Postpartum Support Society, visit their website here:


Facebook – https://www.facebook.com/pages/Pacific-Post-Partum-Support-Society/120735171295360

Twitter – https://twitter.com/postpartumbc

Thank you so much for submitting your question.  Just a reminder that depending on the volume, we may not be able to answer every single question.  To stay up to date with us, sign up for our newsletter below!

Join Pelvic Rehabilitation Medicine’s Newsletter for the latest news and pelvic health information.

Dr. Allyson Shrikhande had a discussion with Dr. Melanie Carminati of Inspira Physical Therapy, about pelvic pain, causes, populations affected, treatment, Pelvic Floor Physical Therapy, and current research being done.

You can learn more about Inspira Physical Therapy by visiting their website:


Follow their social channels:

Instagram – https://www.instagram.com/inspiraphysicaltherapy/

LinkedIn – https://www.linkedin.com/company/inspiraptpilates/

YouTube – https://www.youtube.com/channel/UCe7eFD2EeWWrXJOK7gGYyIA/

Dr. Shrikhande was featured on the Living A Better Life podcast to talk about the PRM protocol for Endometriosis that they use at Pelvic Rehabilitation Medicine.

Here is a description of that show:

In this episode, I interview Dr. Allyson Shrikhande about endometriosis. We dive into prevalence, symptoms of endometriosis that you may not have considered as a typical sign, why diagnosis is challenging, how endometriosis is linked to pelvic floor dysfunction and nerve sensitivity and what you can do about it. Dr. Shrikhande takes us through the PRM protocol they use at her clinic.

For more information on Dr. Madelaine Golec and Ecophysio, visit their website:


Follow their social channels…

ECO Physiotherapy:
Facebook – https://www.facebook.com/ECOPhysiotherapy/
Instagram – https://www.instagram.com/ecophysiotherapy/

Living A Better Life Podcast:
Facebook – https://www.facebook.com/livingabetterlifepodcast/
Instagram – https://www.instagram.com/livingabetterlifepodcast/

Our very own, Dr Charity Hill, is joined by Dr. Linda Kiley of Palm Beach Center for Pelvic Health and PT Gail O’Neill of Pelvic Health Solutions where they discuss the journey a pelvic pain patient takes to find relief.

For more information on Palm Beach Center for Pelvic Health, visit their website at:


Follow their social channels:

Facebook – https://www.facebook.com/urogynecologypalmbeach/

For more information on Pelvic Health Solutions, visit their website:


Follow their social channels:

Facebook – https://www.facebook.com/Pelvichealthsolutionsfl/

Instagram – https://www.instagram.com/pelvichealthsolutionsflorida/

LinkedIn – https://www.linkedin.com/company/pelvic-health-solutions-florida/

Dr. Shrikhande was featured on the Fempower Health podcast to talk about How Pelvic Floor Rehabilitation Can Help You in Surprising Ways

Here is a description of that show:

FemPower Health interviews Dr. Allyson Shrikhande, the Medical Director of Pelvic Floor Rehabilitation. Dr Shrikhande shares what pelvic floor rehabilitation is and how it helps with feelings of UTI, pain with intercourse, and other women’s health-specific conditions. She also addresses questions brought up by members of our Women4ReprodutiveHealth Facebook group.

Keep up with Fempower Health


Dr. Shrikhande was featured on the Bedside podcast to talk about pelvic health and why it matters.

Here is a description of that show:

Did you know that about 15% of women of childbearing age in the United States report having pelvic pain that lasted at least 6 months? Or that the rates of chronic pelvic pain range from 14-32%, worldwide? On today’s episode I chat with Dr. Allyson Shrikhande, a board-certified Physical Medicine and Rehabilitation specialist, and founder of Pelvic Rehabilitation Medicine, who shares with us her expertise on pelvic health — what it is, why it’s so vital we know about it, and how to incorporate caring for it in our everyday. Dr. Shrikhande shares with Bedside her passions and dedication to helping men and women who suffer without anyone willing to listen, understand and find the cause of their discomfort.

Keep up with Bedside:
Instagram – @thebedside
Website – www.thebedside.co

Pelvic Rehabilitation Medicine’s, pelvic pain specialist, Dr. Christian Reutter speaks to Men’s Health about pelvic pain in men.

He is quoted saying:

According to Dr. Reutter, the pelvic floor consists of a network of muscles that act as a “sling” to support the pelvic floor organs (the prostate, bladder, rectum and seminal vesicles), stabilize the connecting joints and assist in bladder, bowel and sexual function. Unlike the muscles you see when you hit the gym, these muscles are mostly internal and (hopefully) not visible to the general public. But they are critical to your everyday function and easily affected by stress, sleep, and other lifestyle factors.

Dr. Reutter adds that working from home, stress, uncertainty, sitting, lack of exercise, and lack of social connection contribute to any of these symptoms.

In addition to breath work, Dr. Reutter suggests you take warm baths, increase aerobic activity (which increases endorphin levels, the body’s natural painkiller) and avoid prolonged sitting on hard surfaces to help relax the pelvic floor and mitigate symptoms.

Dr. Reutter and Dr. Weber go deep on a few common conditions below. If you are experiencing the symptoms described here, reach out to one of these experts to help determine the true cause of your symptoms and whether or not there is more you can do. If not addressed, your pelvic pain could have a large range of effects, from reducing your ability to produce power during your workout to impacting you emotionally and socially.



The prostate is a small gland located directly below the bladder that enlarges over time. According to Dr. Reutter, prostatitis consists of swelling and inflammation of the prostate gland. This gland secretes a fluid that helps constitute semen or seminal fluid. Prostatitis can be bacterial or non-bacterial. Non-bacterial prostatitis is more common form and can be due to nerve irritation, chemical irritation, stress, and often a weak or spastic pelvic floor. Symptoms normally include painful urination, pain w ejaculation, and pain in the groin, genitals, and pelvic floor.


Levator Ani Syndrome

The levator ani is one of the muscles of your pelvic floor. It is primarily responsible for preventing urinary incontinence and supporting the pelvic organs. Dr. Reutter explains that this syndrome can be due to chronically contracted pelvic floor muscles.

Symptoms often present as pain in the rectum resulting in an “achy” feeling during and after intercourse, pain with bowel movements, constipation, and/or a feeling of rectal “fullness” or pain. Dr. Reutter notes: “Patients often describe a feeling of a ‘golf ball’ or similar in the rectum.” He adds that stress, anxiety, chronic constipation, a history of hemorrhoids, anal fissure, and prior colorectal surgery are all causes of levator ani syndrome.

View the original piece placement on Men’s Health.

Helpful video from PRM’s Dr. Jana Scrivani

Social-distancing can be hard for some people. Watch this video of Dr. Scrivani sharing some tips for remaining calm and relieving stress during this difficult time.

A full transcript of the Managing The Stress of Social Distancing can be found below:

Hi, everybody! I’m Dr. Jani, a licensed psychologist, and I’m here to talk to you today about a very timely subject: managing stress in the age of social distancing and home quarantine.

So, if anyone out there is like me, given the area of the country that I live in, I have not really left my house since Friday, with short breaks to take walks and get some fresh air, and things like that. So, what I’d like to do is offer you some tips that you can use to manage the absolutely expected stress and anxiety that all of this is no doubt bringing up, and then how to manage it when you’re stuck in your house or your apartment.

Number one… This is my top 10 list. So, number one: limit your news exposure. I cannot stress this enough. So, if you find yourself stuck at home, and you’re just watching endless news, and constantly reading, and looking for updates, what that’s doing is ratcheting up your stress and anxiety without actually providing you with a lot of useful information. So, how I like to do this is pick one reputable news source, check it no more than one time per day. That will be enough so that you’ll get the accurate information that you need without increasing your stress levels.

Number two: give yourself a smell right now. A little sniff. When was the last time you took a shower? Create a regular routine. So, it can be really tempting to just have a free flow day, but routine and structure are things that we as human beings thrive on. So, create a routine for yourself, including showering, getting dressed, eating regular meals. Definitely will help to keep that stress in check.

Number three: try and get some fresh air at least one time per day. So, of course there are a lot of us who are either strongly suggested or perhaps even under mandate to stay in our homes. But social distancing doesn’t mean that you can’t, let’s say, take a bike ride where you don’t come within six feet of other people. Or take a socially distanced hike. Or a walk. If you happen to be lucky enough to live in New York City, folks are telling me that Central Park, everyone’s being very respectful of maintaining social distance, and is a great place to go and get some of that fresh air.

Number four: prepare to get aggravated like you have never been before at the people with whom you live. So, whether that’s your kids, your partner, your parents, friends. And you want to prepare yourself for this. The more time we spend under stressful circumstances, in close proximity with each other, the more stressful things get, and the more likely we are to have conflict with people.

So, an interesting exercise: take a moment, write down a list of five things you love about the people who you’re living with right now, and take that out when you have the urge to snap at them or respond in a way that you won’t feel proud of later. Remind yourself of why you love these people and why you care about them. Practice assertive conflict resolution.

Number five: there are lots of memes going around about “quarantinis” and other creative ways to spend your time in isolation. You really want to limit your use of alcohol and other substances right now. And there’s a great acronym to help yourself ask, “Okay, why am I having an urge to drink or use a drug right now?” And the acronym is HALT. H-A-L-T. It stands for “Am I hungry? Am I angry? Am I lonely? Am I tired?” And I’m going to add also bored. So, when you’re having an urge to take a drink, ask yourself that question. And if you are hungry, angry, lonely, tired, or bored, take steps to try and resolve that.

Okay, number six, maybe the most important one: take a moment, be kind and gentle with yourself. You are not going to be the perfect homeschooling parent. You’re not going to be the perfect partner. You’re not going to be the perfect friend, the perfect employee. Remind yourself that at any given moment you are doing the absolute best that you can, and that is all you can expect of yourself.

Number seven: social distancing does not have to mean social isolation. Humans are social creatures, and this is one of the reasons that people are struggling with this particular viral outbreak so much right now, is because all of the structures of our society that we go to as humans, right now they’ve pretty much stopped functioning. So, if you live alone, this is going to be even more important. Plan times to do FaceTime dates with people in your life. Set up online meetings, phone calls. Reach out to people you know who live by themselves and who may need extra support right now. So, you might have to find that it takes a little bit of extra effort to get that social interaction that you need, but it is so incredibly important right now.

Number eight: something that helps me, because let’s face it, I’m scared, you’re scared. I think everybody right now is feeling scared, and anxious, and worried about the future. And something that I like to do is remind myself of everything that we’ve gotten through together as a society. Whether it was a World War, or the Swine Flu epidemic, September 11th, we have witnessed, and some of us in our lifetimes, catastrophic events; and as a society, we have never failed to emerge from them and get through them. And we will get through this one too.

Number nine: it is completely normal right now to feel increased stress and anxiety. As I just mentioned, everybody is feeling it. We’re feeling it because we’re human, and we’re living through a time of unprecedented uncertainty, and that is the perfect storm for anxiety and stress. Ride those feelings like a wave. Don’t stuff them down and don’t suppress them. Allow yourself to feel. Allow yourself to experience anxiety and sadness about what’s going on. It doesn’t make you a weak or bad person. It makes you a human. No feeling is final, and no feeling is fatal. Remind yourself of that. It’s completely impossible for these feelings to last forever, but likely they will come and go like waves. And just like a surfer, we have to ride those waves of emotion until then eventually crash.

Number ten: it is more important than ever to reach out for assistance if you need it. And I’m going to post all of these resources that I’m sharing with you right now underneath this Facebook Live once it gets saved to my page.

If you live in New York and you need assistance with food, housing, rent, dial 211. That is your resource for New York City.

There is a friendship line specifically created for older adults who might be feeling particularly socially isolated right now, and that number is 1-800-971-0016.

The National Crisis Hotline: 1-800-273-8255.

The National Crisis Text Line: so text “Home”, that’s H-O-M-E, to 741-741 to initiate a chat with a crisis counselor.

And finally, the National Domestic Violence Hotline. They provide services to people in 200 different languages. They’re open 24/7, and can be reached at 1-800-799-7233.

If you’re already receiving psychotherapy or psychiatric care, check in with your providers. A lot of providers are offering video sessions right now. I’ve been offering video sessions for years, and so have many practitioners, and a lot of practitioners are starting to offer them now so that you can continue receiving therapy during this time of increased stress.

If you’re currently under psychiatric care, now is a good time to call your psychiatrist and make a plan to make sure that you don’t run out of your psychiatric medications.

So, all of those things are some proactive things that you can do now. And if you do not have a therapist and you’re looking for one, tons of therapists across the country are currently offering video sessions to folks in need. So, reach out for help if you need it. There are a couple of organizations that can help you find a therapist, and I will also post those at the bottom of this Facebook Live once it gets posted to my professional page.

Thank you for coming and listening. Stay safe out there, take good care of yourself, take good care of each other, and I’ll probably be back with more Facebook Lives soon. If there’s any topic that you’re interested in hearing me speak about, just leave a comment on this Facebook Live, and I’ll do my best.

All right, everybody, take care.

Dr. Shrikhande was featured on the IC Wellness podcast with Elisabeth Yaotani.

Here is a description of that show:

Are you experiencing pain with sex?

I get a lot of questions regarding sex and intimacy, so I thought we should dedicate an entire episode to this topic. In Episode 21 of the IC Wellness Podcast, I share my personal experience and approach and my guest, Dr. Shrikhande, discusses why sex is painful and what proactive steps you can take to address the root cause. Support is available and there is hope in returning to a normal sex life!

Dr. Allyson Shrikhande is a board-certified Physical Medicine and Rehabilitation specialist, and the Chair of the Medical Education Committee for the International Pelvic Pain Society. She is working with other experts in the field of chronic pelvic pain to develop training modules for residents and physicians interested in learning about the diagnosis, treatment, and management of chronic pelvic pain. A leading expert on pelvic health and a respected researcher, author and lecturer, Dr. Shrikhande is a recognized authority on male and female pelvic pain diagnosis and treatment. She is part of the Manhattan-based Pelvic Rehabilitation Medicine team that is committed to research in order to further understand complex pelvic pain conditions.

One of our OB/GYN and board-certified pelvic pain specialist, Lora Liu, MD, was quoted by Romper about the reasons to have sex after your pregnancy.

She was quoted saying:

1. Your Body Is Ready

The 6-week waiting period after a vaginal delivery is for the vaginal mucosa to heal. Additionally, many women require stitches in the vagina (after an episiotomy or natural tearing), and it takes approximately 6 weeks for those to dissolve. So after about a month and a half, your body is ready when you are to have sex again.





2. It Helps You Feel Like Yourself Again

The changes that your body undergoes during pregnancy are completely normal, but they can have a really serious impact on your self-image and self-esteem. The transition into being a mother is a beautiful thing in many ways, but sexual intimacy after giving birth can help a lot with regaining the feeling that your body still belongs to you.



Read the original article placement on Romper.


Pelvic Pain with Sitting and Intercourse Patient Testimonial Transcript

So my name is Jason. I’m from Montreal. About a year ago, started having pain in my pelvic area. The longer I sat, the more I would feel a discomfort or burning, same thing for walking. And it would also limit my ability to be intimate with my partner because of the discomfort and it sort of lead me to question what was going on. And I saw a few different doctors, nobody could really come up with an answer. And then I just went online and I Googled Pelvic Rehabilitation and up came Doctor Ahmed’s name and her practice.

The staff was extremely friendly upon my first arrival. It’s a very comfortable setting. And, of course, when I met Doctor Ahmed, she really put my mind at ease that this problem is correctable, that with the right treatment and the right health regimens that things could go back to normal or as close to normal as possible. The treatments consisted of injections and they were guided by ultrasound, so Doctor Ahmed was able to target the muscles that were in a contracted state and the source of the pain ultimately. And those injections really helped kind of relax the muscles and enable the discomfort to slowly go away.

I would definitely recommend them. They’ve definitely taken me from a place where I was in a lot of pain to significantly less pain. And I would definitely recommend them to anyone in a similar situation.

Pain During Intercourse Patient Testimonial Transcript

My name is Mike and I’m from Cliffside Park, New Jersey. In July of 2011, I was 24 years old and I was introduced to this woman through a mutual friend of mine and on our first date we had sex. I felt the worst pain of my entire life, like a snapping in my penis, and I instantly knew something was wrong.

A couple of days later, the pain had not subsided. I sought out a urologist. I was given all these courses of treatment that were horrible. I mean, I’ve been poked, I’ve been prodded. I was told I couldn’t have ketchup, I couldn’t eat pepper. I work in television and I was told that I couldn’t drink coffee. This wasn’t like an erectile dysfunction. This was literally a loss of sensation. I would have sex and literally not feel anything. I literally suffered with this for six years and I had countless girlfriends in between.

Now we’re in 2017. This problem started July of 2011 and I still don’t feel anything during sex. I made an appointment with Dr. Ahmed in January of 2018. I get an email with the name, Pelvic Rehabilitation Medicine and it was like music to my ears. There was a doctor named Dr. Ahmed who actually dealt with this.

Dr. Ahmed put me on a treatment plan that actually helped and not for nothing, this is an emotional rollercoaster. Dr. Ahmed didn’t give up on me, even when I wanted to give up on myself. She started putting me on a plan that included seeing a sex therapist, going to physical therapy and seeing her, and she would call me and just be like, hey, how’s everything going? I have never had a provider do that for me.

I am so happy to say that I had sex recently and it felt awesome. I hope that somebody out there listening who is suffering will take a stand, will go to the doctor, will be seen, will come here to Pelvic Rehabilitation Medicine. Please call Dr. Ahmed. If I help somebody out there, if I help just one person, then I know I’ve done the right thing.

Urinary Urgency and Frequency Patient Testimonial Transcript

My name is Genie. I’m from upstate New York. Kind of started about five years ago. I started feeling this constant urgency to urinate. I didn’t have incontinence. I didn’t have issues urinating. It was just a constant urge to, but it was beyond feeling the urge. It was painful. It would be at least a few times per hour some days. A ridiculous amount. And sometimes I would be able to actually urinate and other times I wasn’t able to and in the moments when I could, it was just such a relief, but then shortly after the urgency would just come back.

As you can imagine, every doctor said, “Oh, it’s probably a chronic UTI,” and I hadn’t really had many UTIs in the past, but every single test I would take would come back negative. But they still would say, “Oh, well, maybe it’s a false negative. We’ll treat you anyway.”

Finally, that led me here to Dr. Shrikhande and the first appointment I had with her, she gave me a pelvic exam. She sat there, she looked at me, she listened to me, I finally felt heard. That was the moment that like my life completely changed. I wouldn’t say that it immediately fixed things and Dr. Shrikhande was very open about this is going to be a journey. I never felt that she was pushing treatment on me and she was really taking a holistic view on this and was like, “There’s a lot of factors here.”

I’ve done another round of injections and we plan to do more and I’m continuing to see a physical therapist weekly. That has just become a part of my routine. I just am in such a better place, or just such a different place than I was last year. Both how I’m feeling physically and how I’m feeling mentally. Just recently I’ve started feeling like I can actually live my life again and do normal things.

It’s just a shame that there are so many people out there that I guess aren’t educated in this area, so many medical professionals. And it just feels like this is something that’s not talked about. I mean, it’s not a really comfortable subject to talk about. This isn’t in your head. It is real and there are people out there that can help.

One of our pelvic pain and board-certified Physical Medicine and Rehabilitation specialists, Allyson Augusta Shrikhande, MD, was quoted in a Women’s Health Magazine article talking about life after pregnancy.

She was quoted saying:

Before I had a baby, I never imagined that my recovery would take longer than a couple of months. But the time it takes to get back to normal after experiencing fecal incontinence can vary greatly, says Allyson Shrikhande, M.D., a physical medicine and rehabilitation specialist at Pelvic Rehabilitation Medicine.

“The first part is re-setting those muscles, which would take about six to eight weeks—and then we have to do a proper neuromuscular re-education for another eight to 10 weeks,” she explains. “It’s about a three- to six-month process.”

Read the original article placement on Women’s Health Magazine.


Dr. Allyson Shrikhande and Dr. Tayyaba Ahmed were featured on How Cum Podcast with Remy Kassimir. Here is the description of that show:

In this week’s episode, we have two brilliant doctors of physical medicine and rehabilitation, Dr. Allyson Shrikhande and Dr. Tayyaba Ahmed, who specialize in pelvic pain. They teach us about a very gender neutral organ; the pelvic floor, and many different causes of pelvic pain. We learn about endometriosis, the seriousness of pudendal nerve/ pudendal entrapment, and why Kegels aren’t always the answer. The doctors answer questions from the Cumpanions and talk thrush, anorgasmia, penis burn, clitoral adhesions, and more. Ahmed and Shrikhande also share their personal experiences as women, mothers, and students during medical school, as well as their first-time stories!

Medical Assistant Position

Full Time – Bethesda, MD / Washington, DC Area

Job Description

We are looking for a motivated, team player to join our growing, specialty medical practice. Some of the skills and characteristics you must possess are:

  • Develops and maintains a high level of customer service
  • Strong organizational, multi-tasking and time management skills
  • Oral and written communication skills; planning and organization; teamwork
  • Demonstrates flexibility with job duties
  • Maintains an applicable, medical knowledge base.
  • Prepares patients for examination by Provider
  • Assists with Ultrasound Guided Injections
  • Excellent Patient Follow Through
  • Knowledge of Insurances
  • Clerical Duties
  • Experience with electronic health record systems

Associates Degree preferred but not required.

Job Type: Full-time

To be considered, please send your resume with a short written account of why you would be best suited for this position to:


Medical Assistant Position – Full Time

Job Description

We are looking for a motivated, team player to join our growing, specialty medical practice. Some of the skills and characteristics you must possess are:

  • Develops and maintains a high level of customer service
  • Strong organizational, multi-tasking and time management skills
  • Oral and written communication skills; planning and organization; teamwork
  • Demonstrates flexibility with job duties
  • Maintains an applicable, medical knowledge base.
  • Prepares patients for examination by Provider
  • Assists with Ultrasound Guided Injections
  • Excellent Patient Follow Through
  • Knowledge of Insurances
  • Clerical Duties
  • Experience with electronic health record systems

Associates Degree preferred but not required.

Job Type: Full-time

Manhattan, NY
Long Island, NY
New Jersey, Bergen County
Miami, FL
Bethesda, MD

To be considered, please send your resume with a short written account of why you would be best suited for this position to:


A physiatrist’s view on pelvic pain: an interview with Allyson Shrikande, MD

Below is the transcript of an interview with Allyson Shrikhande, MD and Michelle Dela Rosa, PT.

Michelle: I’m here with Dr. Allyson Shrikande, founder of Pelvic Rehabilitation Medicine in New York and recently Hoboken, NJ. Thank you for speaking with me.

A lot of people ask us about the practice of physiatry. Some people know how it’s pain management, but they don’t really know how it’s different than seeing their gynecologist or their urologist in the way they would treat their pelvic pain. So, can you give me a general overview to describe physiatry and how it treats pelvic pain differently than their gynecologist or their urologist.

Allyson: Sure, thank you so much for having me, Michelle, this is great. For a physiatrist treating pelvic pain, we help the other doctors treat the muscles, the nerves, and the joints of the pelvis in a non-operative approach.

Michelle: How would that be different–can you give me examples of treatments that people may not see with their doctor that they’re already seeing?

Allyson: Essentially, we want to look at it from more of a sports medicine approach, seeing if the pelvic pain is coming from the pelvic floor musculature. Are the muscles in spasm and potentially irritating the nerves of the pelvis, causing some pain? So that’s where we would come in when we’re evaluating patients. Is there a pelvic floor muscle spasm, which we call pelvic floor hypertonia and can cause pain in patients. And we’re really trying to evaluate why this is happening and is there anything from the sports medicine standpoint where we can identify a cause and help to find a proper diagnosis and treatment.

Michelle: I was lucky enough to be able to shadow you for an afternoon and I noticed that while you were treating patients, you were interested in not just recognizing that there was spasm, but like you said, what else could be contributing to it. So what other things do you look for that could be contributing to pelvic spasm?

Allyson: From the musculoskeletal or the sports medicine standpoint, you want to see if there’s anything going on in the lumbar spine that can cause pelvic floor dysfunction. Or is there anything going on in the sacroiliac joint? Or you want to consider the hips–are the hips working, functioning well? And is there any underlying pathology in the hips as well as what we call the pubic symphysis, which is the joint in the anterior aspect of the pelvis. In addition, is there anything going on from the other specialties as well that could be causing this secondary guarding of the pelvic floor muscles? So is there a gynecological reason if it’s a female, or urological reason if you’re male or female, or maybe from the GI system, etc? But you really want to say, ‘Is there anything else going on here that’s causing these muscles to go into this guarding state where it’s really not letting go very well?’

Michelle: This is interesting because so many of my patients say they’ve gotten a diagnosis of pelvic spasm, but they didn’t really get checked out. As a physiatrist, you are doing a pelvic exam?

Allyson: When you see us, we would do a full exam–again looking at your back, your hips, etc–but we do end the exam evaluating your pelvic floor both externally and internally. So we do an internal exam. I always tell our patients that we’re not gynecologists, so we’re really looking at the muscles and distribution of the nerves internally. But we would do an internal exam and it does not require a speculum. It would be similar to an internal exam of a pelvic floor physical therapist–we really look at the tone of the muscles, the strength, and the lift of the pelvic floor, and follow the nerve distribution internally to see if there’s any increased sensitivity or pain internally.

Michelle: Wonderful, we have such a growing population of men coming to see us for pelvic pain as well. And they’re always curious how your exam would be different or how you would be able to help them because they’re hearing that a lot of these treatments are for women. Would they be able to access you and what would you be able to offer them?

Allyson: We see a lot of men here at Pelvic Rehabilitation Medicine, about equal amounts of men and women. From the muscle, nerve and joint standpoint, the anatomy is actually the same. For us, evaluating men and women, it is a similar approach. For the men, we do look at your lumbar spine, hips, and abdomen, any concern for underlying hernias that could have been missed. But then we do an internal pelvic floor exam as well–it would be internal rectally, also evaluating the muscle’s tone and lift and any nerve tenderness internally. With men it would be a similar approach trying to see if there is any possible underlying cause for pelvic floor guarding. And then it’s a full body treatment approach where we really can–we call it down-regulate–or calm down the nerves, of both the central and peripheral nervous system and increase blood flow to your muscles, and get the muscles longer and stronger to rehabilitate the pelvic floor.

Michelle: Many of our patients have been seeing multiple providers. And I noticed that in your practice, you seem to be a gateway to many of the other providers, sort of–coordinating care. Is that part of your model of care and how would you say your practice runs differently than other practices that treat pelvic pain?

Allyson: Definitely. We see ourselves as the quarterback here, because as rehabilitation doctors, we really are trained from the beginning to look at the whole body and the interplay between multiple organ systems. So quite often, we are talking to a patient, and in our minds, thinking if there’s any other specialist that we would need to bring into the picture to help us get this patient better. We work closely with specialists who are excellent in treating the pelvic pain from their angle. But we do see ourselves as the quarterback kind of sending as needed, as well as working closely with pelvic floor physical therapy, to figure out how to get our patients better and what other specialty is needed to calm down their muscles and their nerves.

Michelle: Some of our patients have been getting injections for their pelvic floor and they’ve been given an option for steroid. I know that you have other options, and also, can you touch upon the imaging that you use to guide you through the injections–if injections are necessary.

Allyson: The way we do our injections, or treatments as we like to say…everything is external, nothing is internal. So it’s all external, along the sling of the pelvic floor, and they’re ultrasound guided. Patients call them their butt injections, that’s kind of what it feels like–it’s not internal, it’s external. The idea behind the guidance is like internal eyes so you can see where you’re going. And in addition, it allows us to do a hydrodissection technique, where we can really open up the fascial planes and create space where there is restriction, particularly where the nerves want to flow. What we’re using to supplement for a steroid, which is derived from plants. The main ingredient is arnica–a lot of people have heard of arnica cream like topical arnica–but this is an injectable form of arnica and in combination with echinacea. So it’s a nice way to promote healing in addition to decreasing inflammation, which is why we love it. I really used it more in my plastic surgery rotation. Post-operatively we would give it out after a surgery so that patients wouldn’t become as bruised and swollen. It would decrease inflammation and promote a faster healing topically. So that’s where the idea kind of came from.

Michelle: I know that one of the positions that you hold is that you’re the Chair of the Medical Education Committee for the International Pelvic Pain Society. How do you feel that the position helps to shape what you do in your practice and helps shape how pelvic medicine is moving for the future?

Allyson: We’re actually lucky enough to be surrounded by amazing, intelligent, pelvic health practitioners who constantly push me to really think about things and learn more. The mission of what we do is educate the future of pelvic health from the medical practitioner standpoint–from both the residency program and urology, as well as gynecology and physiatry and any pelvic floor physical therapist who’s had training there–just to try and increase awareness for the people who are training, that the pelvic floor itself is its own distinct entity. And although it does not show up in imaging, we really should not ignore it, particularly when the workup is normal and the patient symptoms persist. So we’re really trying to raise awareness and at an earlier stage in physician’s medical careers, in hopes of getting all our patients recognition earlier and treatment earlier. Because we really believe that is the key–early recognition and early treatment, to squashing it early and getting patients better.

Michelle: What’s the range of people that you see in terms of how long patients have had pelvic pain for prior to seeing you? Is there a range?

Allyson: It’s getting better by the day. But still at this point, the average is six months to 25/30 years worth of symptoms. Even six months is rarest. It’s really along the lines of 1.5 years to 25 years.

Michelle: Hmm, yeah. So, both of us are working on that.

Allyson: We have to work together.

The Pelvic Messenger: Discussing Pelvic, Bladder, Bowel, and Sexual Disorders

pelvic-messengerPelvic messenger, supported by the International Pelvic Pain Society and Beyond Basics Physical Therapy, is devoted to the promotion of diagnoses, recovery, and success in treating Chronic Pelvic Pain (CPP) conditions in men, women, and children. Furthermore, we are dedicated to improving patient and healthcare providers education on CPP. The founder, Elisabeth Oas, along with the managers, Amy Stein, DPT, and Alexandra Milspaw, Ph.D. want to accomplish this mission by discussing up to date topics and research on pelvic and sexual pain and dysfunction. Hosts: Alexandra Milspaw, Ph.D., Amy Stein, DPT, Michelle Waterstreet and Stephanie Stamas, DPT.

Mission Statement:

To provide educational talk radio shows on various chronic pelvic pain topics. In addition, we seek to provide hope and healing to individuals who suffer from pain related symptoms. We will be having shows on all the many diseases and syndromes, which can make up CPP. The show is a message of hope and healing.

Dr. Allyson Shrikhande: Healing Pelvic Pain as a Team

The founding doctor at Pelvic Rehabilitation Medicine, Dr. Allyson Shrikhande, recently had the honor to sit down with the team at The Pelvic Messenger and talk about her collaborative approach to treating pelvic pain.

Listen to the full interview on The Pelvic Messenger’s Blog Talk Radio page or through the embedded player below.

Abigail Bayer−Mertens Human, Charity Hill MD, Tayyaba Ahmed DO, Gautam Shrikhande MD FACS, Allyson Shrikhande MD

Pelvic Rehabilitation Medicine, New York, NY

Endometriosis is a disorder characterized by the abnormal growth of uterine tissue outside of the uterus. Its symptoms are known to be painful and debilitating to patient functionality. Treatment options for these symptoms are not well understood despite a growing need. The objective of this study is to determine the effectiveness of pelvic floor musculature trigger point injections and peripheral nerve hydrodissection in treating endometriosis symptoms, associated pain and pelvic functionality.


Study Design and Outcomes.
The participants in our study consisted of 16 female patients, aged 21-67, with endometriosis. Pre-treatment, all patients were evaluated with a detailed history and physical exam. This included an internal pelvic floor evaluation. Each patient took part in physical therapy before and throughout the treatment process, with individualized pelvic floor physical therapy programs.


Treatment consisted of ultrasound guided pelvic floor trigger point injections to the iliococcygeus, pubococcygeus, and puborectalis. The first two injections combined 1% lidocaine with dexamethasone, while the next 4 injections consisted of 1% lidocaine. Nerve hydrodissection allows the nerves to reset, decreasing hypersensitivity. These treatments were performed once a week for 6 weeks, and were all office based and ultrasound guided. Patients were evaluated using two scales to quantify their pain and functionality before treatment and 3 months after treatment; the 0−10 Visual Analogue Scale (VAS) and the Functional Pelvic Pain Scale (FPPS). The FPPS rates pelvic functionality in 8 categories: bladder, bowel, intercourse, walking, sleeping, working, running, and lifting. The patient rates each category from 0 to 4, with 0 being normal functionality, and 4 being severe debilitation. Thus, each patient can be given a total score from 0 to 32.


The mean age of patients was 32.4. Pre-treatment, the mean VAS score was 6.00 (SD 2.68) and post-treatment the mean VAS score was 2.94 (SD 2.59); P<.05, 95% CI 1.16-4.97. The mean total FPPS score before treatment was 14.44 (SD 5.24)  and post-treatment it was 9.13 (SD 5.75); P<.05, 95% CI 1.34-9.28. Analysis of the subcategories within the FPPS indicated the improvement was statistically significant in the categories of intercourse, sleeping, and working. In the category of intercourse the mean score before treatment was 3.07 (SD 1.14)  and post-treatment it was 1.79 (SD 1.48); P<.05, 95% CI 0.26-2.31 . In the category of sleeping the mean score before treatment was 2.00(SD 1.22) and post-treatment it was 0.85(SD 0.8); P<.05, 95% CI 0.32 -1.99. In the category of working, the mean score before treatment was 2.00 (SD 0.96)  and post-treatment it was 1.14 (SD 0.77); P<.05, 95% CI 0.18-1.53 .


This study set out to determine the effectiveness of pelvic floor musculature trigger point injections and peripheral nerve hydrodissection as a treatment option for endometriosis related symptoms. Analysis suggests the treatment was effective at relieving pain related to endometriosis; it also reflected promise in improving overall pelvic functionality, particularly in relation to intercourse, working and sleeping. This study provides the foundation for future research with larger sample size and longer follow up.

Abigail Bayer-Mertens Human, Tayyaba Ahmed DO, Charity Hill MD, Gautam Shrikhande MD FACS, Allyson Shrikhande MD

Pelvic Rehabilitation Medicine, New York, NY

Patients with chronic pelvic pain syndrome (CPPS) often have debilitating symptoms and decreased functionality related to their pelvic organs and pelvic floor musculature.  CPPS is underdiagnosed and treatment options are not well researched.  The objective of this study is to determine the effectiveness of alpha-2 macroglobulin therapy in patients with CPPS.

One promising CPPS treatment is the usage of alpha-2 macroglobulin as a protease inhibitor to mitigate inflammation and pain. Alpha-2 macroglobulin, a regenerative, non-opioid treatment option, is a plasma glycoprotein which occurs naturally in humans.  This retrospective study analyzed the effectiveness of alpha-2 macroglobulin in eleven patients, seven male and four female, with CPPS. Patients were aged 31-59, and additionally had diagnoses ranging from central pain syndrome, interstitial cystitis, and endometriosis. Patients were initially evaluated with a detailed history and physical exam, including internal pelvic floor evaluation. All patients had unsuccessfully attempted other treatments for their pain in the past. Patient’s scores on the Visual Analogue Scale (VAS) and Functional Pelvic Pain Scale (FPPS) were collected pre-treatment and 12 weeks post-treatment. The FPPS is a scale which measures 8 categories (bladder, bowel, intercourse, walking, sleeping, working, running and lifting) to determine a patient’s functionality in relation to their pelvis. The scale rates each category from 0 to 4, with 0 being normal and 4 being most debilitating. The patient can thus be given a total score from 0 to 32.

Patients all continuously underwent weekly physical therapy. Approximately 90 milliliters of the patient’s blood was drawn and centrifuged with the APIC system to separate its components. The alpha-2 macroglobulin concentrate (8-10 milliliters) was thereby isolated and then injected locally under ultrasound guidance in the region of the iliococcygeus, pubococcygeus, and puborectalis muscles. Pudendal nerve hydrodissection was also performed.

The mean age of the patients was 42.9. Pre-treatment, the mean VAS score was 5.18 (SD 2.48) and post-treatment the mean VAS score was 3.18 (SD 1.54); P<.05,  95% CI 0.16-3.84. Pre-treatment, the mean overall FPPS score was 12.36 (SD 5.80) and post-treatment, the mean overall FPPS score was 5.55 (SD 4.27); P<.05, 95% CI 2.29-11.35. Analysis of the subcategories within the FPPS indicated the improvement was statistically significant in the categories of bowel, intercourse, walking, sleeping, working and lifting. Pre-treatment, the mean FPPS bowel score was 1.36 (SD 0.67) and post-treatment it was 0.45 (SD 0.52); P<.05,  95% CI 0.37-1.45. For intercourse, the mean FPPS score pre-treatment was 2.56 (SD 1.24) and post-treatment it was 1.00 (SD 1.50); P<.05,  95% CI 0.18-2.93. Pre-treatment, the mean FPPS walking score was 1.88 (SD 0.83) and post-treatment it was 0.88 (SD 0.83); P<.05,  95% CI 0.11-1.89.  For sleeping, the mean FPPS score pre-treatment was 1.67 (SD 0.71) and post-treatment it was 0.67 (SD 0.50); P<.05,  95% CI 0.39-1.61.  Pre-treatment, the mean FPPS working score was 2.5 (SD 0.71) and post-treatment it was 1.5 (SD 0.85); P<.05,  95% CI . For lifting, the mean FPPS score pre-treatment was 2.25 (SD 1.16) and post-treatment it was 0.38 (SD 0.74); P<.05,  95% CI 0.83- 2.92.

This study has promising results in regards to the usage of localized alpha-2 macroglobulin as a novel, regenerative, non-opioid treatment option for patients with CPPS. This study also provides the foundation for further research into this topic, which will involve larger sample sizes and longer follow-up.

Sports Hernia: Causes, Treatments, and Symptoms at Pelvic Rehabilitation Medicine located in New York City

Sports Hernia Video Transcription

Very often, we have patients who present with abdominal tenderness which likely is a sports hernia. A sports hernia is a weakness in the soft tissue and muscle area around their pubic symphysis and their lower abdomen. This is important because these muscles are their core muscles, and the core muscles are part of your pelvic floor as well. So if you have a weakness there, you will have a weakness in your pelvic floor and thus causing the pelvic pain. Having a sports hernia can now result into pelvic pain because of their weakness in their abdominal muscles and their core. Then patients may present with pain in their groin, they may present with pain going down their leg, pain in their hip. Pelvic pain does radiate, and it does not just stay in one location, so it can mimic other things like lower back pain.

Patients with sports hernias can attribute this from being very active. Oftentimes, they are athletes or have active lifestyles. We’re evaluating their lumbar spine, we’re evaluating their hips, we’re evaluating their abdomen and checking to see if they could have a potential hernia. When patients have sports hernias, we also have to treat the underlying pelvic floor dysfunction that they may have.

Typically, we do that with pelvic floor physical therapists, possibly some Valium suppositories, maybe a nerve medication for any neurogenic inflammation, if they need, we may do hydrodissection nerve blocks and trigger point injections to their pelvic floor. And at the same time, we’re hopefully working with a hernia surgeon to evaluate if there is a need for repair of the sports hernia. When patients present with pelvic pain, we’re trying to understand where their pelvic pain is coming from and why they have it. Until we figure out what’s causing the issue, the pain won’t resolve.

Causes of Vaginismus: Causes, Treatments, and Symptoms at Pelvic Rehabilitation Medicine located in New York City

Causes of Vaginismus Video Transcription

Vaginismus is a tightness of the muscles around the vagina. Primary vaginismus can be caused by when they are trying to have intercourse for the first time, or they’re trying to use a tampon for the first time. It’s now like this trauma that is causing them to tighten up. We do evaluate them and try to figure out where is this coming from.

Secondary vaginismus is typically when patients who previously could have intercourse and previously could use tampons are now unable to do this. Other causes for vaginismus are postpartum changes in their hormones, recurrent yeast infections.

Vaginismus can be relieved by a multi-modal approach. Often we will prescribe patients with Valium suppositories to relax their pelvic floor muscles. They can use dilators under the supervision of a pelvic floor physical therapist. They can also be treated with hydrodissection nerve blocks and trigger point injections to their pelvic floor muscles.

Chronic Pelvic Pain Endometriosis: Treatment and Relief Options at Pelvic Rehabilitation Medicine located in New York City

Chronic Pelvic Pain Endometriosis Video Transcription

Endometriosis is a chronic inflammatory condition where you have lesions that are like plaques that can grow anywhere in the abdominal cavity. And so typically people say that it grows just on the outside of the uterus instead of inside of the uterus. But it can actually grow anywhere on the abdominal wall, sometimes on the bowel and sometimes on the diaphragm. And then oftentimes on the pelvic floor, which can lead to other pelvic pain syndromes that we treat, specifically pelvic floor dysfunction, as those lesions can cause direct inflammation into the muscles and nerves of the pelvic floor. It can start affecting the quality of the muscle tissue, it can affect the blood flow, it can affect the nerves in the area and create neurogenic inflammation. And it can also start affecting the central nervous system or the way the brain processes pain.

A lot of patients come into us nervous because they’ve all heard there’s no cure for endometriosis. But we really look at the whole system to try to relieve the pain of endometriosis by treating all the other systems that can be affected by it. We really work best in conjunction with other providers like the endometriosis surgeons. Sometimes we need to refer to an orthopedic surgeon if people start having other issues with their hips get involved. There really is hope for pain relief from endometriosis. A lot of times it’s just finding the right providers and treatments to give you that relief. I find that it’s very helpful for me having gone through the pain and suffering of endometriosis. I understand because I’ve felt those same strange sensations before that no one else has been able to understand. And I’m able to give that affirmation back to the patient and say, “No, I’ve dealt with this too. What you’re experiencing is real and that’s a symptom that goes along with endometriosis.” I just think of how much my quality of life would have improved if I was able to seek these treatments sooner. And that’s why we’re trying to reach out to people at a younger age to try to prevent these things going on for years and years and causing mental anguish that really we could help prevent.

Male Pelvic Pain: Types, Conditions, and Causes for Men at Pelvic Rehabilitation Medicine located in New York City.

Male Pelvic Pain Video Transcription

We always laugh when people ask us if we are women’s health, because when we first started we thought we would only have women patients, but the men just showed up. I have very young patients in their 20s, late teens, up until their 60s or 70s.

The symptomology of male pelvic pain can differ from females because of the difference in genitalia. The number one chronic pelvic pain symptom that a male usually presents to us is with pain with sitting. Males will present with testicular pain, testicular numbness, rectal pain, rectal numbness, pain in their perineal region, urinary frequency, urgency, burning, chronic constipation, diarrhea, abdominal tenderness, or abdominal pressure, bladder pain, coccyx pain, and not being able to have pleasurable intercourse.

Some potential causes of pelvic pain in men are IBS, Crohn’s disease, ulcerative colitis, interstitial cystitis, or abacterial prostatitis, inguinal hernia or a sports hernia, hemorrhoids. If you have a tailbone injury, that can cause pelvic pain. Athletic injuries, especially if it relates to your hip. Most males do not talk about their pelvic pain issues to anybody, and if they do, it may be to a spouse or partner. This is a very private issue and a lot of people are not speaking about it. Most of our male patients which encompass about 30% of our practice find us by Google. They are concerned with their livelihood. We understand that. We want them to be able to enjoy the things that they used to be able to enjoy.

The most important thing for male patients to understand is that although this is a very sensitive topic, we are very experienced in what we’re doing. We understand what you’re going through regardless of the fact that we’re females. We see this so often and we have great success with our treatment protocol.

Dr. Tayyaba Ahmed was featured on The Period Party Podcast with Nicole Jardim and Nat Kringoudis. Here is the description of that show:

Dr. Tayyaba Ahmed is an osteopathic physician who is board certified in Physical Medicine and Rehabilitation. She is also a contributing author to the textbook Pelvic PainEssentials of Physical Medicine and Rehabilitation, and a collaborator in the Northwell ROSE Study for endometriosis research.

In this episode, we talk about common causes and symptoms of pelvic pain, the relationship between endometriosis and pelvic pain, the issues surrounding endometriosis surgery, the impactful goal for the ROSE study, how you can participate in the ROSE study, and so much more!

Here are the highlights of what we cover during this episode: 

  • What is pelvic pain?
  • Misconceptions about physical medicine and rehabilitation (PM&R) physicians, also known as physiatrists
  • The most common types of pelvic pain and associated symptoms
  • What is endometriosis?
  • The relationship between endometriosis and pelvic pain
  • Symptoms of endometriosis and how they usually present
  • Why endometriosis tends to remain undiagnosed for so long
  • The importance of early diagnosis for women with endometriosis
  • The questions to ask yourself to determine if your symptoms point to endometriosis
  • Other conditions associated with pelvic floor dysfunction
  • Ahmed’s observations about post-partum pelvic pain
  • Nat shares her experience with pelvic pain
  • What to look out for if you’re considering surgery for endometriosis
  • The reason ablation surgery remains so widely used
  • How the success of the ROSE study would impact women’s health
  • How to be a part of the ROSE study

Resources & Recommendations:

Female Pelvic Pain Video Transcription

Female pelvic pain is a complex multifaceted condition. For women, it can be felt in their vagina, in the lower abdomen, in the lumbar, in the sacral region, the buttocks, and then, of course, the entire pelvic region where it can be felt in something called the perineal area. It can go down their leg, it can radiate up towards the thoracic spine, quite often it can be felt in the bladder, and the urethra, and/or the rectum.

Some things that are unique to females are vulvodynia and/or vaginismus, underlying gynecological disorders such as endometriosis, polycystic ovarian syndrome, uterine fibroids, and/or ovarian cysts that can cause pelvic pain, vaginal delivery. There is a strong hormonal component to pelvic pain with females. You can have something called pubic symphysis dysfunction or pain in your pubic symphysis, sacroiliac joint dysfunction, this can happen with pregnancy itself with or without a vaginal delivery.

What is Pelvic Pain? Transcription

Dr. Shrikhande: Pelvic pain is a complex multifaceted condition, mainly because in the area of the pelvis, there really is quite a bit going on. Issues in the bladder can actually crosstalk and cause issues in the pelvic floor and so on. Pelvic pain can be felt in the lower abdomen, in the lumbar, in the sacral region, the buttocks, and then, of course, the entire pelvic region where it can be felt in something called the perineal area, it can go down their leg, it can radiate up towards the thoracic spine. For men, it can be felt in their penis, in their testicles. For women, it can be felt in their vagina, quite often it can be felt in the bladder, and the urethra, and/or the rectum.

Patients with chronic pelvic pain have sensitization of their nervous system. Their nerves are hyperexcitable or hyperactive, and essentially firing too much. We always start with pelvic floor physical therapy, in addition, we always add daily diaphragmatic breathing, meditation of some patients, we’ll add some craniosacral work, some acupuncture, some medical massage or connective tissue work, and some yoga, depending on the patient. We have patients that come in to see us who have high-stress level jobs and have type A personality and often are sitting the majority of the day.

Dr. Ahmed: Oftentimes, we see a lot of patients who are professional athletes who developed pain from repetitive microtraumas to their pelvic floor.

Dr. Hill: I try to get them out of that state of despair that it’s so easy to get sucked into when you’re suffering day-to-day.

Dr. Ahmed: When they talk to me, they’re usually very tearful and upset because they don’t have anyone to talk to. For those patients, I try to see if I can connect them with another patient with their permission. I also encourage them to find different outlets like Facebook, different organizations.

Dr. Hill: Sometimes it’s just helpful to talk to people who understand and who’ve had the same conditions as you have, and kind of troubleshoot with them things that have worked and to get support.

Dr. Ahmed: I think the most important thing is that patients with pelvic pain should know that they are not alone and that they can find help and support.

Dr. Tayyaba Ahmed was featured on RUSK Insights on Rehabilitation Medicine podcast. This is part 2 of 2. Here is the description of that show:

Dr. Tayyaba Ahmed is a doctor of physical medicine and rehabilitation. A native of New York City, after spending five years honing her skills in outpatient care, Dr. Ahmed focuses on her passion for treating pelvic pain, believing that concentrating on a specific field creates the greatest expertise. A board-certified Physical Medicine and Rehabilitation physician, Dr. Ahmed also is a fellow of the Academy of Physical Medicine and Rehabilitation and a member of the International Pelvic Pain Society. She completed the BS/Doctor of Osteopathic Medicine program at New York Institute of Technology and was trained at the New York College of Osteopathic Medicine, Northwell Health Plainview Hospital, and the NYU Langone Medical Center/RUSK Institute for Rehabilitation.

In Part 1 of this two-part interview, Dr. Ahmed discusses: kinds of interventions involved in pelvic rehabilitation; types of health problems that necessitate pelvic rehabilitation; roles played by factors such as age and gender in determining which patients are candidates for pelvic rehabilitation services, and biofeedback as an effective technique to enhance positive outcomes and how it is used.

Dr. Tayyaba Ahmed was featured on The Women’s Pelvic Pain Podcast podcast. Here is the description of that show:

In this episode, I sat down with Dr. Tayyaba Ahmed, a pelvic pain specialist at Pelvic Rehabilitation Medicine in NYC. Dr. Ahmed is an osteopathic physician, board certified in physical medicine and rehabilitation. We discuss many components of pelvic pain, including the mind-body connection, the stigma against pelvic pain, what Dr. Ahmed’s practice entails and how she treats her patients.

Dr. Tayyaba Ahmed was featured on RUSK Insights on Rehabilitation Medicine podcast. This is part 1 of 2. Here is the description of that show:

Dr. Tayyaba Ahmed is a doctor of physical medicine and rehabilitation. A native of New York City, after spending five years honing her skills in outpatient care, Dr. Ahmed focuses on her passion for treating pelvic pain, believing that concentrating on a specific field creates the greatest expertise. A board-certified Physical Medicine and Rehabilitation physician, Dr. Ahmed also is a fellow of the Academy of Physical Medicine and Rehabilitation and a member of the International Pelvic Pain Society. She completed the BS/Doctor of Osteopathic Medicine program at New York Institute of Technology and was trained at the New York College of Osteopathic Medicine, Northwell Health Plainview Hospital, and the NYU Langone Medical Center/RUSK Institute for Rehabilitation.

In Part 1 of this two-part interview, Dr. Ahmed discusses: kinds of interventions involved in pelvic rehabilitation; types of health problems that necessitate pelvic rehabilitation; roles played by factors such as age and gender in determining which patients are candidates for pelvic rehabilitation services, and biofeedback as an effective technique to enhance positive outcomes and how it is used.

Dr. Allyson Shrikhande Bigraphy Video Transcription

My name is Dr. Allyson Shrikhande. I am a Doctor of Physical Medicine and Rehabilitation. I went to medical school at the Royal College of Surgeons in Dublin, Ireland, and then went on to do my internship in general surgery in Boston at Harvard Medical School, then did my residency at NYU and Physical Medicine and Rehabilitation. Now, I’m a practicing physiatrist or physical medicine rehabilitation doc who treats male and female pelvic pain.

The main society that I’m involved with is the International Pelvic Pain Society, otherwise known as IPPS. I am the Chair of Medical Education Committee. I am board certified in physical medicine and rehabilitation. I am a member of the National Vulvodynia Association, giving patients with vulvodynia options for treatment. I am also a member of the New York City PM&R Society, also am member of pudendal.org. I got interested in the field of pelvic pain when I was first pregnant. I had difficulty walking and couldn’t figure out what it was at first, ended up being sacroiliac joint pain and dysfunction and pelvic floor muscle dysfunction.

At the time, had trouble finding someone to help me, and that made me realize that there’s a large need in this field for medical practitioners. The passion for pelvic medicine really started when I met a patient that flown to New York City from L.A. She was in her mid-20s and had been complaining about pelvic pain symptoms for over 10 years. After 10 years of being sent from psychiatrist to psychiatrist, she arrived in our office extremely frustrated and very concerned for why there was not a diagnosis. She was eventually diagnosed with endometriosis, however, it was late stage endometriosis, and I really feel that if we can educate both the medical professions and patients that, we can catch things earlier and allow people to suffer less and not feel that they’re alone and/or crazy.

Pelvic Pain Endometriosis Patient Testimonial Transcription

Ever since I was younger, I would get stomachaches a lot and have kind of different stomach pain. And it wasn’t terrible. And then when I got to college it got a little bit worse. I would say it would get sometimes like very full after meals and I guess bloated, and also would get really strong lower pelvic pain. So it almost felt like I had like a band on my lower abdomen. And then it was post-college when it got so bothersome that I kind of started seeing doctors more proactively.

A lot of times specialists only know their specific area. So, you know, the gynecologist, was like, “It’s not a gynecological issue, go to a urologist.” Urologists like, “Go to a GI doctor.” The GI doctor’s like, “Go to this other doctor.” And then finally I got referred to Dr. Shrikhande. And lo and behold after seeing Dr. Shrikhande for a full year, she figured out I had Endometriosis. You know, it’s a disease that affects a lot of women but all these in 10 years of seeing doctors, no one had ever figured it out, and I think because Dr. Shrikhande is one, so caring, but two, so holistic and looks at everything. She was able to kind of listen to all my symptoms and look at the bigger picture, and I think really helped get to the root of what was causing my pain.

You know, she’s so 24/7 if you ever have questions, responds within 24 hours. And I think that was really helpful and made me want to keep going back to her. She was very helpful in having the right procedures done. So I had CAT scans done and MRIs done, and before we actually realized I had endometriosis, she also did a lot of things that help with just general pain management. I did a course of the different nerve injections with her, which was really helpful and I think kind of temporarily helped to numb and some of the pain I was having. She not only was a great doctor herself, but also referred me to kind of a network of other people then who were very helpful. When you go on Yelp and look at the best doctor, you know, you don’t really know actually is this like a good doctor you’re going to. She referred me ultimately to the surgeon I ended up using and was in constant communication with him.

Going to so many doctors, it’s so frustrating not to share your story over and over again. She’s able to give all my background and honestly took a lot of pressure off of me because I had been doing for the year acupuncture and physical therapy, it made it so that I was actually able to recover much more seamlessly. I would recommend Dr. Shrikhande to anyone. She’s an excellent doctor and really cares about her patients and takes full ownership and goes above and beyond, outside of just being with her patients during the session. She thinks about you, sends updates, asks how you’re doing. She gets to know the other doctors in your network and makes sure that everyone’s working together to help manage her patient’s pain. She’s just wonderful.

Pudendal Neuralgia Video Transcription

Pudendal Neuralgia is pain in the distribution of the pudendal nerve and its branches. Pudendal neuralgia can be felt along the sit bones, along the rectum, along the perineum, and along the vaginal area, as well as the testicles and penis in males. Symptoms of pudendal neuralgia are achy, burning, stabbing, sharp, knife-like pains in the distribution of the pudendal nerve, which includes from the sit bones and buttocks, out to the rectum, or perineum, and/or the vaginal area, or the testes and penile area in the men. It’s often worse with sitting, as sitting does put pressure on the pudendal nerve, and it can be associated with pain with bowel movements. It is not associated with any sensory loss or sensory deficits.

Potential causes of pudendal neuralgia are anything that can put pressure along the pudendal nerve, from its course from the lower sacral nerve roots, down to the rectum and the vagina. Vaginal childbirth could put pressure on the nerve during delivery. A bladder sling operation can put pressure on the nerve and any other surgery that could cause scar tissue. Entrapment of the pudendal nerve which can come from higher up, from the lumbar sacral plexus, and injuries to the ligaments, where the pudendal nerve courses under.

The pudendal nerve can be injured. The most common way would be a stretch injury. However, the pudendal nerve, in most cases, can heal with time.

Persistent Genital Arousal Disorder (PGAD) Video Transcription

PGAD, or Persistent Genital Arousal Disorder, also goes by “restless genital syndrome” or “persistent sexual arousal syndrome.” PGAD symptoms, which are often extremely distressing to the patient, are unwanted, unpleasant sensation of arousal and/or orgasms, that the patient is unable to control. Women who come in to Pelvic Rehabilitation Medicine with symptoms of PGAD often feel that they don’t have control over their life, as it’s very challenging to have this unwanted, unpleasant sensation throughout the day, and extremely disturbing to their quality of life, their ability to function, at work and at home, and in relationships, and, often, their ability to get quality sleep.

The underlying cause of Persistent Genital Arousal Disorder is unknown. There are multiple theories, some including lumbar sacral causes, where there could be lumbar spine pathology, or something called a Tarlov cyst, that could be contributing and causing compression of the nerves that are related to arousal. There could be some hormonal contributions to Persistent Genital Arousal Disorder. There can be some causes associated with descending modulation from the brain, and that could potentially upregulate the nerves that lead to arousal and orgasm, and there could be some pressure from an underlying gynecological disorder. And there could be some role in the pelvic floor muscles itself putting tension on the nerves, that can increase arousal and orgasm in a patient. So we will evaluate a patient, try and find the cause, and then essentially try to relieve pressure on the nerve itself, and also try and calm patients down from chronically tensing their muscles and from activating their nervous system via either high levels of anxiety and/or depression.

There is debate in the medical community if PGAD can go away. We have had success in treating it here with our protocol. However, the longevity of the treatment is still yet to be determined.

Allyson Shrikhande, MD, founder of Pelvic Rehabilitation Medicine, has submitted an abstract for the International Continence Society’s Annual Meeting. The International Continence Society (ICS) has over 3,000 members and is a thriving society of Urologists, Uro-gynaecologists, Physiotherapists, Nurses, Basic Scientists and Researchers with a focus on continence and pelvic floor disorders. We are growing every day and welcome you to join our Society.

Here’s the link to the presentation abstract: https://www.ics.org/2018/abstract/306

International Continence Society Abstract:

A Novel, Non-Opioid Based Treatment Approach for Men with Urologic Chronic Pelvic Pain Syndrome (UCPPS) Using Ultrasound-Guided Nerve Hydrodissection and Pelvic Floor Musculature Trigger Point Injections

Urological Chronic Pelvic Pain Syndrome (UCPPS) represents a group of pain symptoms relating to patients with pelvic pain that are poorly understood and for which treatment is largely unsatisfactory. Newer nomenclature has combined Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) and Interstitial Cystitis/Painful Bladder Syndrome (IC/PBS) into a single classification of UCPPS. The objective of this study is to analyze the effects of a novel treatment strategy in males suffering from UCPPS.

This retrospective, institutional review board approved study analyzed eight male patients aged 24-61 with UCPPS.  All patients had a trial of antibiotic therapy, and had pelvic floor physical therapy pre and post taking part in the study. Patient’s scores on the Visual Analogue Scale (VAS) and Functional Pelvic Pain Scale (FPPS) were collected pre-treatment (Figure 1).  While continuing physical therapy, patients underwent ultrasound-guided pelvic floor trigger point injections to the iliococcygeus, pubococcygeus, and puborectalis. The first two injections combined 1% lidocaine with dexamethasone, while the next 4 injections consisted of 1%lidocaine, and a plant-derived anti-inflammatory medication. Concomitantly, patients received peripheral nerve hydrodissection performed on the pudendal nerve and the posterior femoral cutaneous nerve. These treatments allow the nerves to reset, decreasing hypersensitivity.  These treatments lasted for 6 weeks.  After completion of treatment, each patient retook the VAS and FPPS. 

The mean age of our patients was 31.8 years and the average duration of symptoms of the UCPPS was 21 months. Pre−treatment, the mean VAS was 3.3 (STD 1.7) and the mean VAS post-treatment was 1.8 (STD 1.4); P<0.05, 95% CI 0.73-2.27.  The mean FPPS pre-treatment was 11.0 (STD 8.0) and the mean FPPS post-treatment was 6.3 (STD 5.3); P<0.05, 95% CI 0.03-9.22.

Our results show promise for a novel, non-opioid based treatment for UCPPS by using ultrasound-guided pelvic floor trigger point injections combined with peripheral nerve hydrodissection with lidocaine and dexamethasone along with a pelvic floor physical therapy program.

Pelvic Rehabilitation Medicine is happy to announce their partnership with the Research OutSmarts Endometriosis (ROSE) Study to further the research in identifying non-invasive methods to diagnose endometriosis as early as possible. Gautam Shrikhande, MD, the medical director at Pelvic Rehabilitation Medicine was quoted in GenomeWeb about the practice participating in this pioneering study. Here’s more at PRM about the ROSE Study.

Feinstein Institute Researchers Develop Noninvasive Endometriosis Diagnostic Assay

Pelvic Rehabilitation Medicine, a New York-based medical center, plans on partnering with the Feinstein Institute to actively recruit patients for future studies to assess the potential impact the test might have on patients in the long term. Its medical director, Gautam Shrikhande said that the Feinstein team should examine important patient-related issues, including the severity of endometriosis cases and the patients’ clinical backgrounds He agreed that the test could help inform the patient’s relatives of their likelihoods of developing the disease.

“If [the patient] can tell their sister, daughter, or other female relatives, it can have a significant impact on the suffering generations to come,” he noted.

With the assay being developed by the Feinstein team, a diagnosis can be done in less than three days, according to the researchers. “We’ve developed an assay that can work with 4,000 cells, and isolate just the SFCs that are there, rather than growing them for three weeks,” Metz explained. “We can freeze menstrual fluid in time in a way that doesn’t kill the cells.”

To read the full article from Genome Web please download the article HERE.

Uncovering the Black Box of Pelvic Pain: Understanding the Role of the Pelvic Floor

Presented By: Allyson Shrikhande, MD


Pain with Bowel Movement Video Transcription

Pain with bowel movement can happen when you have underlying pelvic floor hypertonia or pelvic floor muscle dysfunction. It can also happen when you have irritation of your pudendal nerves which often come with pelvic floor muscle dysfunction.

A risk factor for having a pain with bowel movements is constipation. So, chronic constipation can ultimately irritate the muscles and nerves of the pelvic floor and cause secondary pelvic floor muscle spasm. And that can spread to both the perineum and the testicles and the base of the penis in men, and for females, it can spread to the vaginal area and the bladder in both men and women, and ultimately lead to Chronic Pelvic Pain Syndrome.

It’s important to address your constipation and let your healthcare professional know about it so that we can address it with both lifestyle and nutrition. Particularly with lifestyle, we have patients do the breathing exercises to help release the spasm in the pelvic floor muscles because often, even just the mechanical restriction of the pelvic floor muscles near the rectum can cause constipation. So it’s important to release the tension in that mechanical restriction.

In addition, diet modification is important. We recommend supplements. Quite often, we use something called magnesium, which can gently promote normal bowel movements daily. Also, we recommend patients to prevent constipation to get the Squatty Potty. It’s a simple maneuver that can really relax the muscles of the puborectalis and pubococcygeus and help the mechanical inhibition of bowel movements.

Pain with Sitting Video Transcription

Pain with sitting presents to us with pain in the sit bone area, and the rectum, and sometimes out to the buttocks, when patients sit down, particularly on hard surfaces.

Quite often, patients who have pain with sitting have a high-stress lifestyle, high-stress job, and sometimes they’re holding their tension throughout the day in their pelvic floor muscles.

It’s important to make sure to get up once every hour, and to do proper breathing. This can help drop the pelvic floor, reset the muscles, and relieve tension in the area.

Something as simple as evaluating a patient’s chair at work, and their lumbar support, and their support for their pelvis, can really help alleviate a patient’s pain with sitting.

Prostate Pain (Prostatitis) Video Transcription

The subset of prostatitis that we would treat is abacterial or non-bacterial prostatitis. Meaning, there was tenderness on the prostate in exam, however, the workup was negative for any prior infection. So the symptoms that we would see here in patients with abacterial prostatitis would often be testicular pain or burning, perineal discomfort or burning in the perineum, penile pain, pain with erection or ejaculation or post-intercourse, as well as urinary symptoms such as burning during urination or frequency or urgency.

Some potential causes is inflammation in the genitourinary system. From when there’s chronic pelvic floor tension and muscle dysfunction, you essentially get release of proinflammatory cytokines from the pelvic nerves. In addition, there’s been some recent research that has shown the importance of the descending modulation from the brain going down the spinal cord to the genitourinary system that can modulate pain and prostatitis itself and the overall urological chronic pelvic pain syndrome.

Therefore, when we do treat patients particularly with urologic chronic pelvic pain syndrome, we not only treat the peripheral nervous system and the muscles of the pelvis and the surrounding soft tissue, but we also treat the descending modulating signals from the brain. Here at Pelvic Rehabilitation Medicine, we work to relieve the symptoms of abacterial prostatitis as they’re intimately connected to tension in the pelvic floor muscles. And we work to relieve that tension and increase blood flow and decrease inflammation around the nerves that can ultimately help with the pain and inflammation associated with the prostatitis.

Charity Hill, MD Biography Video Transcription

I’m Dr. Charity Hill. I am a medical doctor. I trained at Temple University for medical school and did my residency at NYU. I got involved in Sports & Spine Medicine because I was a competitive athlete. When I decided to focus on pelvic pain, that became really helpful as a lot of the structures we treat are very deep and can only be properly imaged using a lot of the techniques that I developed in my orthopedic training.

I joined the International Pelvic Pain Society, and that’s a group of physicians in multiple specialties that all work together to try to tackle the complicated aspects of pelvic pain. So, when I first began having pelvic pain, I registered it as a sports injury just because I was playing sports around 30, 40 hours a week. Went to multiple orthopedic surgeons and our team doctor in college and they just weren’t able to really figure it out.

When I was on my OBGYN rotation in medical school, we had a pelvic pain patient coming into the clinic. My attending said, “Ah, it’s these pelvic pain patients, you know? It’s just all in their head, there’s nothing we can do for them.” I myself had pelvic pain, and I remember just thinking to myself, “Oh my gosh, am I just crazy?” For a couple years I just kept my mouth shut and actually didn’t seek any medical care, and I thought I could maybe make it go away if I just ignored it. At one point I knew I really needed help when my medical assistant came in to get me for a patient, and I was laying on the floor of my office and that was kind of my rock-bottom when I was like, “No, I really need to treat myself as well as treating other patients.”

Finally, gotten to a doctor who was able to figure it out that I had endometriosis, and I was really grateful I eventually found someone. Though I figured if I had that hard a time finding care, even though I was already in the medical field, I figured it must be so much more difficult from people who are coming from outside that field to get care. And I decided I wanted to focus my career on educating people on the realities of pelvic pain and giving treatment to those kind of patients. I’m very grateful that I am able to use all the information that I’ve gathered over the years in order to help treat these patients who are suffering so badly.

So, there was a quote I heard once, “Pain is inevitable, but suffering is optional.” For a while I didn’t have much hope that I was ever gonna get to a place where I was going to be able to function like a normal person, but it’s wonderful to have hope for the future and have hope that you’re able to be who you really are and not let the pain rule your life.

Tailbone Pain (Coccydynia) Video Transcription

Coccydynia is pain in your coccyx or tailbone area. Coccydynia or tailbone pain is felt directly in the coccyx area. It is typically worse with sitting, particularly on hard surfaces.

Potential causes of coccydynia would be pregnancy and particularly vaginal delivery, certain athletic activities such as horseback riding or bike riding, a history of a fall on a patient’s coccyx or trauma to the coccyx such as a fracture, as well as pelvic floor muscle dysfunction or pelvic floor spasm, where the muscles are pulling on the coccyx, and that will irritate the nerves around the coccyx. Part of the treatment for coccyx pain is to have a proper cushion when you sit down, to relieve pressure on the coccyx.

You Can Help Us Learn More About Endometriosis

Pelvic Rehabilitation Medicine has partnered with Northwell Health in the Research OutSmarts Endometriosis (ROSE) Study to help discover an early detection test for endometriosis. The research and participant selection is being done through the Feinstein Institute for Medical Research at Northwell Health in partnership with the Endometriosis Foundation of America and Pelvic Rehabilitation Medicine.

ROSE Study FlyerIf you’re a woman living with endometriosis, or you suspect you might have it and are scheduled to have surgical treatment, you may be eligible to participate in the ROSE Study. Your immediate family (siblings, parents, and children), if they do not have endometriosis, may also be eligible to join the study. ROSE Study researchers are exploring what causes endometriosis and if a better treatment can be developed. To participate in the study, you will be asked to:

1. Older than 18 years
2. Not pregnant or breastfeeding

To participate in the study, you must be:

1. Share medical/demographic information
2. Answer questions about how endometriosis affects her life
3. Provide a blood sample (from the arm)
4. Offer a sample of menstrual flow that can be collected at home using a simple procedure; this collection is optional
5. Allow ROSE Study researchers to collect excess endometrial tissue samples from a past or future surgery

Participants will be compensated for their participation.

If you would like to learn more about how you may play a part in improving the understanding of endometriosis, please contact a research nurse at 516-562-ENDO (3636), email ROSE@northwell.edu, or visit us at ResearchOutSmartsEndo.org.

Download the research participation flyer HERE.

Rectal Pain (Levator Ani Syndrome) Video Transcription

Rectal pain is also known as Levator Ani Syndrome. What it is is spontaneous episodic pains in the rectum that are secondary to spasms in the pelvic floor musculature. These pains are said to last at least 20 minutes at a time, and as they do progress they can last longer. Patients often say that it’s a sensation of a golf ball in their rectum. Patients say that they have a dull ache in their rectum, or a burning, itchy sensation in their rectum. Risk factors for Levator Ani Syndrome include a history of hemorrhoids or hemorrhoid surgery, history of an anal fissure, history of prolonged sitting, particularly sitting on a hard surface and with poor posture, or chronically holding your stress in your pelvic floor muscles, and it can be aggravated with intercourse. It may be relieved with bowel movements. It is important to let your doctor know that you’re experiencing these symptoms, because research has shown that the earlier that we catch and diagnose and treat it, the easier it is for us to make patients better. The longer things persist, the more challenging it is for us to make it go away. Really because it starts to become your new normal, both in the way your muscles are set, the way your muscle spindles are, as well as the way your nerves are trained and the way they function. So if we catch it early, we can retrain the muscles and the nerves faster, and with a better prognosis.

Painful Erection / Painful Ejaculation Video Transcription

Male patients can experience pain during erection or ejaculation or pain post erection or ejaculation. Painful erection and painful ejaculation quite often comes from inflammation around the nerves that are involved in the process. There are multiple reasons they could be inflamed. Sometimes there is scar tissue around where the nerves flow from a previous surgery, such as an inguinal hernia repair or sometimes it’s purely from the persistent pelvic floor muscle spasms that ultimately lead to inflammation around those nerves involved in the erection and ejaculation process that causes the pain. We do see quite a bit of erectile dysfunction when patients do present with pain with intercourse to us. Trigger points in the muscles are nodules in the muscle fibers and these nodules can restrict the blood flow, essentially, in the surrounding tissue. And this restriction of blood flow ultimately proliferates in inflammatory cascade, which can lead to inflammation around the nerves and pain with erection and ejaculation.

Tayyaba Ahmed, DO Biography Video Transcription

My name is Dr.Tayyaba Ahmed. I am an osteopathic physician. I went to school at NYIT, which was a program with New York College of Osteopathic Medicine, and then I went to NYU where I met Dr. Hill and Dr. Shrikhande. I pursued sports medicine for a few years, and now doing pelvic rehab primarily. I had two kids, one in residency and one after residency. And most women will tell you that when you go back to working out and exercising you may have a little bit of leakage doing jumping jacks. And a lot of doctors and women think it’s normal to have that, you can actually improve the muscles of their pelvic floor, and doing that can prevent that leakage.

When I first got introduced to the pelvic pain world, a colleague had offered me an opportunity to edit a chapter for the Frontera textbook, the chapter was the pelvic pain chapter which I thought was a great opportunity to learn about pelvic pain and use what I’ve learned from Dr. Shrikhande. Since starting with Dr. Shrikhande, I have done many talks, one for the NYU health professionals, and one for Beyond Basics. I have also done some community talks, and at the National College of Osteopathic Surgeons Conference, I spoke about non-surgical treatment options for pelvic pain.

Pelvic Pain During Sex (Dyspareunia) Video Transcription

Dyspareunia is pain with intercourse or pain post intercourse. Pain with intercourse itself can have a strong emotional impact. Quite often, it can lead to avoidance of intercourse with your partner. It can lead to relationship issues with your partner. It can lead to a fear of intercourse and this fear can lead to something we call Vaginismus. When patients are in fear of intercourse, the muscles surrounding the vaginal opening can clamp down, so to speak. It can also lead to emotional distress, anxiety, as well as sleep disturbances, all secondary to the pain with intercourse. We do always ask, is it more of a superficial burning sensation? Which can often be associated with entrance pain or Vulvodynia symptoms, and at that point, it’s important to evaluate any underlying hormonal cause or underlying infection such as a yeast infection. Or is it more of a deep, penetrating pain? The pelvic floor muscles are important in evaluating and treating as well as any underlying organ disorders potentially within the female system such as ovarian cyst or a fibroid.

Audio: Pelvic Floor Dysfunction

Vulvar Pain (Vulvodynia) Video Transcription

Vulvodynia is vulvar pain. For vulvodynia to be labeled chronic, it has to be going on for over six months. Symptoms of vulvodynia include a sensation of throbbing or burning, or some patients say a rawness in the area, that can be heightened with intercourse specifically, or for some patients it’s heightened with prolonged sitting. There could be an underlying hormonal imbalance that leads to vulvodynia. There could be an allergic reaction, it could be secondary to pelvic floor muscle dysfunction, there also could be a potential injury or damage to a nerve that innervates the vulva area. An additional cause of vulvodynia could be recurrent vaginal infections.

Vulvodynia can either be constant or intermittent. It can be described as provoked or unprovoked. Provoked meaning when you touch the area there’s pain, but if you’re not touching the area there is not pain. Vulvodynia can be generalized where the entire vulvar hurts a patient, or it could be localized to a specific area in the vulva. So the pelvic floor musculature, which is a sling of muscles, can have trigger points just like any other muscle in the body. It can benefit from a release of the trigger point. Sometimes it’s myofascial release from a physical therapist and sometimes it can be from a trigger point injection performed by a physician, where you would like to break up the trigger point and release the tension, ultimately increasing blood flow to the area. And blood flow is healing and provides oxygenation and will overall make the muscles feel better.

Audio: Pelvic Floor Dysfunction

Pelvic Floor Dysfunction Video Transcription

Pelvic floor muscle dysfunction is dysfunction in the muscles of the pelvic floor. It can be something called hypotonic, where the muscles are extremely lax. And there is something called hypertonic. Pelvic floor hypertonia is where the muscles are short, spastic, and weaker, and essentially there’s reduced capacity for the muscles to lengthen. Therefore, they are not supporting the above structures as well as we would like them to be, including the bladder, the uterus, and the colon, as well as the hips and the lower spine and sacrum.

In addition, when the muscles are short, spastic, and weaker, there is less blood flow to the area. And when there’s less blood flow, there’s less oxygenation, and this can lead to a drop in the pH levels. And this essentially is what stimulates something called an inflammatory cascade. And when this whole inflammatory cascade is stimulated, you get release of these pro-inflammatory cytokines that we describe as an inflammatory seep, and this is what ultimately leads to neurogenic inflammation, where the nerves of the pelvis then start to fire inappropriately.

So the symptoms that can come with this are: rectal burning, rectal pain, pain with sitting, burning with intercourse, pain with bowel movements, urinary urgency, frequency, and burning with urination, all related to both the muscle dysfunction, where the muscles are in spasm and weaker, and then, eventually, over time, causing inflammation in the peripheral nervous system.

Audio: Pelvic Floor Nerve Hydrodissection

[/et_pb_text][et_pb_text _builder_version=”3.0.97″]

Pelvic Floor Nerve Hydrodissection Video Transcription

Peripheral hydrodissection nerve blocks under ultrasound guidance are a simple day procedure that is not surgery. Patients go back to work the same day. In the nervous system, you have the central nervous system which is the spinal cord and the brain, and then you have the peripheral nervous system which is everything else that comes out of the spinal cord. In the pelvis, there are multiple nerves that come from the lumbosacral plexus to innervate the pelvis.

The goal of the peripheral hydrodissection nerve blocks is to create space in the fascial planes where the peripheral nerves flow, so there’s less restriction and ultimately more blood flow. In addition, the goal is to reset or retrain hyperactive peripheral nerves and also to decrease any inflammation that can occur around these peripheral nerves that all these things contribute to pain in the pelvis.

We treat an array of extremely complex, chronic pain symptoms, and we have a Triplex approach that is extremely safe and minimally invasive and effective.

Audio: Chronic Pelvic Pain Syndrome

Chronic Pelvic Pain Syndrome Video Transcription

Chronic Pelvic Pain Syndrome can originate for the male, it can originate from the prostate, in the testicles, from the epididymis. For the female, it can originate from the ovaries, or the uterus, or the vagina. It can originate from the intestines, or the muscular-skeletal system, or the neurological system, or colorectal system.

In terms of that, we would evaluate any system that we feel is necessary, and that requires an additional workup to see the cause of Chronic Pelvic Pain Syndrome. In addition to an underlying cause within the organ systems, lifestyle plays a large role with chronic pelvic pain, and by that we mean stress and how patients deal with stress, as well as their athletic ability and what they’re doing for athletics, whether it’s putting a lot of pressure on their pelvis in terms of microtraumas, or pressure on their coccyx, or pudendal nerve.

Nutrition plays a large role with chronic pelvic pain patients. Nutrition can help decrease inflammation in the body. Nutrition can help decrease different hormonal levels such as estrogen in the body, as some issues with pelvic pain are estrogen-dependent pathologies. Nutrition can also help affect the bladder. And there’s something called interstitial cystitis diet that can help calm down the bladder and stop irritating the bladder.

So those would be the lifestyle options for instigating and/or proliferating underlying pelvic floor muscle dysfunction and Chronic Pelvic Pain Syndrome.

Audio: Painful Bladder Syndrome

Painful Bladder Syndrome Video Transcription

Interstitial cystitis is also called chronic bladder pain syndrome, because essentially you’re constantly having pain in the bladder. It’s very common in people with endometriosis, and in fibromyalgia. And it can just be something that cripples people, in addition to having chronic pain in the pelvis and other places in the body.

The bladder rests right along the pelvic floor muscles, which wrap from the pubic bone in the front, to the tailbone in the back. And so, when the bladder is inflamed or irritated, it can irritate the muscles underneath, as well as some of the nerves and blood vessels that run close to it.

Painful bladder syndrome can often be misinterpreted as a urinary tract infection. The biggest difference is, on testing at the doctor’s office, you’ll get negative tests and negative cultures which can be really frustrating for both the patient and the doctor, as they’re trying to figure out what’s going on. And it’s very disabling, interrupts sleep, and can be very misunderstood by other providers on the medical community, who will again, often think that it’s a psychiatric issue or something else going on with the patient, that it has nothing to do with an actual physiological problem.

The potential signs and symptoms of painful bladder can be: frequent urination, only urinating in small amounts, burning with urination, feeling like the bladder’s full when its not. A lot of people would notice tenderness in the bladder.

There is a correlation in patients who have painful bladder syndrome and pelvic floor dysfunction. And sometimes we’re not sure which one came first, because we’re seeing patients so far down the road. But, the general belief is that if you have painful bladder syndrome it can cause pelvic floor dysfunction, and if you have pelvic floor dysfunction it can cause painful bladder syndrome. So typically, by the time we see patients they’re suffering from both at the same time, and so we work on treating both simultaneously.

There are many treatments for painful bladder syndrome and some of those may be medications or injections that can help release the pressure on the pelvic floor, which then relieves the pressure on the bladder that may be contributing to the frequency of urination and to the pain symptoms involved.

The road to relief from endometriosis and its related pain can be long and confusing. Listen to a patients journey over a decade period finding bringing her to a position of comfort. Endometriosis pain can manifest in many different ways, one being chronic pelvic pain and numerous other associated conditions.

Video: Endometriosis Pain Patient Testimonial

Audio: Endometriosis Pain Patient Testimonial

Endometriosis Pain Video Transcription:

My pain started even before, like, my menstrual cycle, so I was very young. At, like, 13, I had this, like, weird pain. And I remember my dad brought me to, like, the store before soccer practice, and he was like, “Get some Icy Hot. Maybe you tore a muscle.” And then once I had my menstrual cycle, it kinda evened out, but I was just, like, bedridden during my periods and everything. And I just thought that was normal. My mom said that she had bad periods, so I kinda just dealt with it.

And then I dropped to the floor one day because I had really sharp pain. I had, like, a cyst on my ovary that was the size of a grapefruit. So I had to have surgery for that, and they questioned endometriosis then. I didn’t know what endometriosis was. I was young still. I thought I would get better after the surgery just for the cyst. And then it would just get, like, worse and worse as the years went by.

So I had a partial hysterectomy when I was 17 or 18. No one should have to have a hysterectomy at 17, and that’s the whole reason why my endometriosis was never excised properly. And it’s common for it to resurface the worst ever after a hysterectomy. You get a few good years, amazing years, but then it comes back, and it hits you just like a tsunami, nothing like I ever felt before.

When I was in law school, I started bringing my heating pad to lectures, and I was, like, losing the battle. And that was the first time I had to, like, put my hands up. And I had to leave school, and couldn’t work, couldn’t even go to the store. I couldn’t eat. I was throwing up from the pain. That was the first time where I felt like, “This is the end.” I was like, “Is this gonna be the rest of my life?” And I was so, like, driven and stayed in school, so then people couldn’t understand socially, like, “Why can’t you just get better? You’ve had surgery.” You know? But they don’t understand, you know?

Some doctors feel like they’ve done all they can do, and they think that you don’t have it anymore. And he told me it was impossible that I had any endo again, and that’s a common theme. You’ll hear that a lot from specialists. I met Dr. Shrikhande through a mutual friend. She was wonderful and kind and warm. And this field is so dominated with males, and it was just so nice to have females to come to, and it was just a different atmosphere. The injections that she did, like, doing it how she did it and following her plan, finally, now, I’m feeling like my old self. So I call it “my flare of a lifetime.”

I feel like everything that occurred and happened to me was just creating, like, “the perfect storm” I like to call it. Even my family members were saying my personality was coming back. I was feeling better because the pain wasn’t at the forefront of my mind all the time. There’s no cure, and I’ll always have issues with the pelvic floor, but that’s why you see a specialist like Dr. Shrikhande.

She makes something that can be very awkward not awkward at all. She’s just very bright and warm, and no matter what state you come in seeing her, you leave feeling happy. And she’s very nurturing, and she makes you feel like it’s gonna be okay. She’s inspired me and has inspired me in how much she’s helped me. I wanna be able to help someone like that because I know what it feels like, and I wanna be able to help change someone’s life. She definitely gave me something back that I lost, and I’m so grateful for it, and I just can’t wait to see what the future holds.

So I’m excited for all the people that are going to benefit from this and feel like me and feel like they’re getting control back over their bodies and their life and have a say in it again. So yeah. I can’t put it into words. I love her, and the whole office is amazing.

Video: Pelvic Health and Rehabilitation Center

Learn about the leading Pelvic Health and Rehabilitation Center treating men and women with an array of pelvic health concerns. Dr. Allyson Shrikhande explains the new treatments they are designing and what to expect as a patient at Pelvic Rehabilitation Medicine.

Pelvic Health Rehabilitation Center Video Transcript:

Pelvic rehabilitation medicine is a practice that helps treat men and women who have pelvic pain from all conditions, from all the etiologies. And we are able to evaluate and help diagnose and treat the underlying cause. One of our goals is to bring exposure to a very misunderstood and misdiagnosed condition in the medical world. It can be very frustrating for patients with pelvic pain because often the imaging is normal, the blood work can be normal, all the cultures are normal.

When you come in into our office here at PRM, you’re greeted by a friendly welcoming staff who is empathetic and understanding that you are in pain and discomfort. We treat pelvic pain, but we understand and are aware of how chronic pain interacts with the rest of your body. And we listen to patients and really focus on them as a whole beyond their pelvis. Pelvic Rehabilitation Medicine was created really to end patients’ suffering and silence and to really let patients know that there are treatment options out there for them.

I really feel that if we can educate both the medical professions and patients that we can catch things earlier and allow people to suffer less and not feel that they’re alone and/or crazy. We’re lucky enough to work with some of the most amazing specialists in pelvic pain so we can help patients get better via teamwork. Being in New York City, we do treat patients from all over the country and really, all over the world. It’s not uncommon that people are flying in for consultations and then for their treatment protocol.

They are able to fly the same day as the treatment. So quite often patients will fly in, have the treatment and then be flying out later on that day, and that’s not a problem at all. At Pelvic Rehabilitation Medicine, we aim to create a calming and healing environment and help patients understand their pain, hopefully, find a diagnosis and then get them on the road to recovery.

Around 16 percent of the female population suffers silently with vulvar pain, yet there are some treatment options that provide efficacy and relief. A challenge of treating vulvar pain or vulvodynia is that patients are embarrassed to report their issue to providers — and it may also be difficult to convey and track symptoms of sporadic, intermittent episodes that are an indicator of this medical condition.

Talk to your provider or practitioner today, and get answers to common questions surrounding vulvar pain:

What is vulvodynia?

Vulvodynia is classified as chronic vulvar pain with no obvious cause, and only recently has it been identified as a chronic pain syndrome. Vulvodynia strikes women of all ages, with no predisposition for any race or ethnicity. There are basically two different types of vulvodynia, localized which impacts a specific area and generalized which may be indicated by roaming or inconsistent pain.

Where is vulvar pain felt?

Vulvodynia can be difficult to talk about, but there are options available from providers. Vulvodynia pain impacts the external female genitals, the vulva, including the labia, vaginal opening, and clitoris. Pain may target a specific spot, or as mentioned, could affect the entire vulva at different times, frequency and severity. The pain of vulvodynia has been described as burning or stabbing, which can make it difficult to diagnose.

How and when is vulvar pain felt?

The defining difference between chronic vulvodynia and other genital pain is the underlying cause: vulvodynia is a condition that lacks a concrete cause or reason. Women of all ages are at risk, and a genetic link has not yet been established. It is difficult to estimate the exact number of women impacted by chronic vulvar pain due to the sensitivity of the topic and reticence for many afflicted to seek treatment, however, it ranges from at least 200,000 to millions of women affected.

What are the risk factors?

While there is no known cause for vulvodynia, there are some factors that can increase or aggravate the condition. These risk factors make you more at risk of contracting chronic vulvar pain and that could increase the severity of vulvodynia symptoms during an outbreak. Some things that contribute to developing vulvodynia include trauma or injury to the vulvar, weak pelvic-floor muscles, nerve abnormalities or injury or a genetic predisposition that affects the body’s response to inflammation. Some other conditions that seem to correlate with chronic vulvar pain and vulvodynia include muscle spasms, frequent use of antibiotics, allergies, hormones or a history of sexual abuse.

Hiding Vulvar Pain

What are your treatment options?

While treatment may not “cure” you of vulvodynia, it may reduce the frequency of symptoms and decrease the severity of the discomfort. Some recommended interventions include physical therapy, and potentially nerve injections, in some instances related to cases of nerve injury or physical trauma. Some other effective approaches to treatment include holistic methods like stress-reduction, meditation, and acupuncture. Some effective ways to reduce discomfort are to avoid irritants (hygiene products, tight clothing), relieve pressure (limit sitting, use cushions, loose-fitting underwear), and manage your pain, with medications or homeopathic options.

Severe cases of vulvodynia merit ultrasounds by your hip and pelvis specialist. They may also utilize trigger-point injections to reduce inflammation, reduce pain, and treat your vulvar pain.

Chronic pain can impact your mood, cause depression and deteriorate your overall quality of life; why suffer from vulvar pain any longer? Talk to your provider about treatment options for vulvodynia or seek the specialized attention and expertise in Pelvic Rehabilitation Medicine.

Chronic pain can throw your entire life intoPirformis Syndrome Pelvis and Leg Pain upheaval: Injuries incur hardship and cost money and time. Furthermore, pain cuts into your normal routine and lifestyle, often making activities, work and family time difficult and uncomfortable. Sometimes you can injure or pull a muscle, such as the piriformis muscle, which is located near your buttocks, that later impacts your mobility and causing chronic discomfort.

What Is Piriformis Syndrome?

Piriformis syndrome is a condition in which spasms occur in the piriformis muscle, creating pain in your buttocks. This muscle’s close proximity to the sciatic nerve also can contribute to the issue, causing nerve pain, tingling, and numbness in your foot and along the back of your leg. Piriformis targets the hip and pelvis area, which is what contributes to chronic pain and limited range of motion.

What Causes Piriformis Syndrome?

The causes of piriformis syndrome are unknown, though spasms in this area of the body and injury to the nearby joints and hip can contribute to the problem. Swelling can occur in the piriformis muscles, causing further irritation and tightening, which could exacerbate your symptoms and pain level.

Symptoms of Piriformis Syndrome

The symptoms of piriformis syndrome are hard to ignore. You may experience a dull pain in the buttock and increased discomfort when you climb stairs or walk up hills. Another common complaint of sufferers is discomfort when sitting or after extended periods of sitting. The symptoms also include decreased range of motion in your hip, which can impact overall mobility and movement, particularly for active individuals. Walking, jogging and running may worsen symptoms, and comfort might be found lying flat on your back.

The best way to determine if the pain you are experiencing is Piriformis Syndrome is to have an examination by a hip and pelvis specialist. They will be able to diagnose the condition before symptoms exacerbate.

Risk Factors of Piriformis Syndrome

The risk factors of piriformis syndrome are straight forward and can be common based on your lifestyle.

  • Childbirth
  • Deviated Coccyx
  • Pelvic Hypertonia
  • Trauma
  • Working Lifestyle

Relieve Symptoms and Treat Piriformis Syndrome

Treatment options vary depending on the severity of piriformis syndrome symptoms and can be noninvasive to quite aggressive. Catching this condition early and beginning treatment is key to preventing complex pelvic issues later on. Stretching exercises have shown efficacy in the piriformis muscle, also impacting the hips and hamstrings favorably. Physical therapy may be a useful recovery tool that educates the patient on how to properly do stretching exercises to bring comfort and promote healing.

Some practitioners may choose pharmacological interventions to help in the healing and recovery of the piriformis muscle. Anti-inflammatory medications can alleviate the swelling that co-occurs with this condition and could provide some pain relief. Some have found relief with deep-tissue massage therapy.

For more severe cases, steroidal and anesthetic injections may be a practical approach. The goal of treating with injections is to relieve pain long enough for the patient to participate in physical therapy, which will have more long-lasting repercussions. Botox is another injectable option that has been found effective at relieving pressure from the sciatic nerve, which may reduce overall pain in patients with piriformis syndrome.

Don’t live with the pain of piriformis syndrome one more day; look into Pelvic Rehabilitation Medicine to relieve your painful symptoms and regain your mobility. The longer you delay assessment and treatment, the more at risk you become for pelvic complications that could require more invasive procedures to alleviate, such as surgery or injections. Get help today and regain your range of motion pain-free with the help of professionals who have experience in this and other chronic pain conditions.

Relevant Publications/Citations

Shrikhande A, Ahmed T, Shrikhande G, Hill C. A Novel, Non-Opiod Based Treatment Approach to Men with Urologic Chronic Pelvic Pain Syndrome (UCPPS) Using Ultrasound Guided Nerve Hydrodissection and Pelvic Floor Musculature Trigger Point Injections. The International Continence Society. 2018 Aug. Link to Article.

Allyson Augusta Shrikhande, MD. Interviewee on Pelvic Health Summit – CPPS. Pelvic Health Summit. 2018 May. Link to Interview.

Allyson Shrikhande, MD sits as the chair of the Medical Education Committee for the International Pelvic Pain Society. Link to Medical Committee.

What is Complex Regional Pain Syndrome?

Complex regional pain syndrome (CRPS) is a chronic pain condition that most often affects one limb usually after a trauma. CRPS is characterized by prolonged or excessive pain and changes in skin color, temperature, and/or swelling in the affected area. CRPS is believed to be caused by malfunction of the nervous system. CRPS represents an abnormal response in the nervous system that amplifies the effects of an injury. As pelvic pain and health specialists, we treat many patients that have CRPS affecting the pelvic region. Whether from trauma or prolonged injury, we can help alleviate chronic pelvic pain.

dr tayyaba ahmed testing for complex regional pain syndrome

What Are The Symptoms of Complex Regional Pain Syndrome?

  • Prolonged Severe Pain
  • May be described as burning or a “pins and needles” feeling
  • Spreads throughout entire limb
  • Allodynia, where normal contact with the skin such as soft cotton is experienced as extremely painful
  • Changes in skin color, temperature, or swelling
  • Changes in hair growth or nail growth patterns
  • Abnormal sweating
  • Stiffness in joints
  • Abnormal movements in the affected limb

Reflex Sympathetic Dystrophy Syndrome Risk Factors

We do not know why some people develop CRPS after trauma or injury and other’s do not.  A prolonged injury or delayed treatment is the same way, some people develop CRPS while other’s do not.

What Are Some Options For Treatment of CRPS?

Physical Therapy: A physical therapy program to promote range of motion and movement of the affected body part can improve blood flow.  Additionally, exercise can help improve the affected limb’s flexibility, strength, and function. Rehabilitating the affected limb also can help to prevent or reverse the secondary brain changes that are associated with chronic pain. Pelvic floor physical therapy is a key piece in the comprehensive treatment protocol we require of our patients.

physical therapy for complex regional pain syndrome

Occupational Therapy: Occupational therapy can help the individual learn new ways to work and perform daily tasks.

Psychotherapy: People with CRPS may develop depression, anxiety, or post-traumatic stress disorder, all of which heighten the perception of pain and make rehabilitation efforts more difficult.  Treating these secondary conditions is important for helping people cope and recover from CRPS.

Medications: Several different classes of medication have been reported to be effective for CRPS, particularly when used early in the course of the disease.  However, no drug is approved by the U.S. Food and Drug Administration specifically for CRPS, and no single drug or combination of drugs is guaranteed to be effective in every person.  Drugs used to treat CRPS include:

  • Bisphosphonates
  • Corticosteroids (in early stages)
  • medications used to treat neuropathic pain, such as gabapentin, pregabalin, amitriptyline, nortriptyline, and duloxetine
  • topical local anesthetic creams and patches such as lidocaine.

All drugs or combination of drugs can have various side effects such as drowsiness, dizziness, increased heartbeat, and impaired memory. Inform a healthcare professional of any changes once drug therapy begins.

Sympathetic nerve block: Some individuals report temporary pain relief from sympathetic nerve blocks, but there is no published evidence of long-term benefit.  Sympathetic blocks involve injecting an anesthetic next to the spine to directly block the activity of sympathetic nerves and improve blood flow.

Additional Treatments Options:

  • Behavior Modification
  • Acupuncture
  • Relaxation techniques (such as biofeedback, progressive muscle relaxation, and guided motion therapy)

Emerging Treatments for CRPS Include:

Intravenous immunoglobulin (IVIG):  Researchers in Great Britain report low-dose IVIG reduced pain intensity in a small trial of 13 patients with CRPS for 6 to 30 months who did not respond well to other treatments.  Those who received IVIG had a greater decrease in pain scores than those receiving saline during the following 14 days after infusion.

Graded Motor imagery:  Several studies have demonstrated the benefits of graded motor imagery therapy for CRPS pain.  Individuals do mental exercises including identifying left and right painful body parts while looking into a mirror and visualizing moving those painful body parts without actually moving them.

If you are suffering from any pelvic health or pain concerns please contact Pelvic Rehabilitation Medicine today to get you on the path to finding relief.

Relevant Publications/Citations

Norman J. Marcus, MD Allyson Augusta Shrikhande, MD Bill McCarberg, MD Edward Gracely, PhD. A Preliminary Study to Determine if a Muscle Pain Protocol Can Produce Long-Term Relief in Chronic Back Pain Patients. Pain Medicine. 2013 Aug; 14(8): 1212–1221. Link to Article.

Allyson Augusta Shrikhande, MD, Robert A. Schulman, Brian S. Lerner, Alex Moroz. Acupuncture for Treatment of Chronic Low-Back Pain Caused by Lumbar Spinal Stenosis: A Case Series. Medical Acupuncture. 2011 Sep; 23(3). Link to Article.

Shrikhande A, Ahmed T, Shrikhande G, Hill C. A Novel, Non-Opiod Based Treatment Approach to Men with Urologic Chronic Pelvic Pain Syndrome (UCPPS) Using Ultrasound Guided Nerve Hydrodissection and Pelvic Floor Musculature Trigger Point Injections. The International Continence Society. 2018 Aug. Link to Article.

Dr. Tayyaba Ahmed was featured on Carly Snyder, MD’s MD for MOM radio show. Here is the description of that show:

This week on MD for Moms, I’ll be interviewing Dr. Tayyaba Ahmed about pelvic pain. Having a baby can cause pelvic discomfort or even pain, but is rarely permanent. What happens when the pain does not go away? How about pelvic pain not associated with pregnancy? Learn the causes and types of pelvic pain and also ways to treat it on this week’s MD for Moms.


Dr. Tayyaba Ahmed is a doctor of physical medicine and rehabilitation who was born and raised in New York. She completed the BS/DO program at New York Institute of Technology and was trained at the New York College of Osteopathic Medicine, Northwell Health Plainview Hospital and the NYU Langone Medical Center/RUSK Institute for Rehabilitation.

board certified Physical Medicine and Rehabilitation physician, Dr. Ahmed is also a fellow of the Academy of Physical Medicine and Rehabilitation and a member of the International Pelvic Pain Society.

Dr. Ahmed is a contributing author to a textbook which is considered a staple during every Physiatrist’s training.  The fourth edition is currently in press and scheduled to publish in the spring of 2019. This full title reference is: Ahmed T, Chan I:  “Pelvic Pain”,  Essentials of Physical Medicine and Rehabilitation, 4th edition by Frontera W,  Silver J, Rizzo T; Elsevier, Philadelphia, In Press.

After spending the last five years honing her skills in outpatient care, Dr. Ahmed is ready to focus on her passion for treating pelvic pain. Dr. Ahmed has chosen a focused practice, because she believes concentrating on a specific field creates the greatest expertise. Chasing that greatness has been her consistent driving force.

How is a Pelvic Pain Doctor Different From Other Specialists?

If you’ve experienced pelvic pain before, you understand how debilitating it can be. It’s especially common in women, but can also occur in men. Pelvic pain can be acute (lasting for a short period of time) or chronic (lasting six months and more). Learning how a pelvic pain doctor is different that other specialists may help you find the care you are looking for.

While your gynecologist or personal doctor can treat acute pelvic pain with medication, chronic pelvic pain is better dealt with by a pelvic pain specialist. Unfortunately, there’s a lot of misinformation out there about pelvic specialists, which can lead to a series of misdiagnoses and worsening pain.

If you’re dealing with pelvic pain, or know someone who does, this article will explore pelvic pain and how a pelvic doctor differs from your local specialist.

Understanding Chronic Pelvic Pain (CPP)

Pelvic Doctor - Charity Hill, MDChronic pelvic pain generally lasts for more than six months. It can be very difficult to pinpoint the exact cause because it’s often the result of many things happening at the same time. And with this type of pelvic pain, it’s entirely possible that the original source of pain may have been dealt with (or healed on its own), yet the pain remains.

Unlike cancer or heart disease diagnosis, tests by your doctor may not result in an accurate diagnosis for your pelvic pain. Even a pelvic pain specialist will need to understand your medical history to get a bearing on what the problem might be. And whatever cause, your pelvic doctor identifies could be just one in a series of problems.

In short, CPP is often unexplained severe pain that can directly affect your muscles and nerves. This condition is often characterized by four levels of increasing pain:

  1. Original injury – CPP can be as a result of a current or previous injury resulting from endometriosis, appendicitis, adenomyosis, Crohn’s disease, colon cancer, bladder or bowel infections, cysts, scar tissue or other complications.
  2. Transferred pain – This level of pain occurs when the original injury pain lasts a long time. As a result, the visceral nervous system comes into contact with the somatic nervous system, transferring the pain back to the pelvis and abdomen. For instance, if you have a resolved uterine problem but the pain remains, you’re at this pain level.
  3. Trigger points on the abdominal wall – After the pain is transferred to the pelvic area, the muscle wall of the abdomen experiences tenderness in specific areas. These are trigger points and explain the pain when you or a pelvic specialist pushes down on an affected area. This could be a major source of pain. One of your treatments is directly aimed at relieving the pain and tension caused by trigger points.
  4. Psychological pain – If your pelvic doctor tells you that your severe pain may be more psychological than physical (often called psychosomatic), don’t take offense. Since your nerves and brain are connected to the spinal cord, the state of your mind could lead to increased pain. In such a case, your pelvic doctor may recommend psychological counseling or physiotherapy.

How a Pelvic Doctor Differs From Other Specialists

With an understanding of how chronic pain can vary dramatically from person to person and between men and women, let’s take a look at how pelvic doctors are uniquely equipped to help treat and manage pelvic pain:

1. A Pelvic Doctor Understands All Possible Complexities

Going to your primary care provider for CPP is like visiting your local dentist to get a root canal. You believe they’re qualified to help, but in reality, they lack the necessary specialized training. To have a root canal, you’d need an endodontist and not a regular dentist.

Pelvic Doctor Office Entrance

In the same way, if you experience pelvic pain for more than six months straight, you’ll want to see a pelvic specialist. A pelvic doctor understands exactly how to deal with any problems related to pelvic pain, including musculoskeletal pain, endometriosis, vulvar pain disorders, painful bladder syndrome, and peripheral neuralgias, among others.

2. Primary Physicians May Not Know How to Control the Pain

A primary physician will almost always focus on the most probable causes of your pain, ignoring psychological factors. But managing psychosomatic pain plays a big part in reducing pelvic pain and improving your quality of life.

According to the International Pelvic Pain Society, CPP can lead to depression, trouble sleeping, lack of appetite, anxiety, and general changes in behavior. A pelvic pain doctor is trained to look for these symptoms and recommend suitable treatment immediately.

3. A Pelvic Doctor Will Avoid Unnecessary Surgery

If you look at the common diagnosis of CPP, endometriosis leads the list for women. This is a condition where the lining of the uterus or similar tissue grows in other parts of the body. Research shows that at least 176 million women around the world suffer from this condition.

To treat this condition, surgery is required to remove the tissue. Unfortunately, only a third of these surgeries result in relief. In addition, CPP is the reason for up to 12% of all hysterectomies. Yet 22% of post-hysterectomy patients still report pelvic pain.

For men the pain can be just as prevalent, but less understood and treated. It is estimated that 10-12% of the male population suffers from chronic pelvic pain. But because of the sensitive nature of the issues, there are only 2 million outpatient visits a year. That is less than 1% of the male population suffering from chronic pelvic pain.

These stats demonstrate the elusiveness, sensitivity and misunderstanding around CPP. If you or your doctor are unsure or have been unsuccessful in treating your pelvic pain it is best to contact a specialist.

Always Look Out For Yourself as a Whole

Treating CPP is “like peeling the layers of an onion”. With one solution often comes another problem. This is because the pain can stem from multiple sources or one distinct source, but it’s often nearly impossible to tell the difference.

That’s why you should always consider seeing a pelvic doctor, even if just for a second opinion. These specialists are equipped to help you manage pelvic pain in the best way possible while working towards a long-term treatment plan.

We Are Doctors Who Specialize Pelvic Pain

At Pelvic Rehabilitation Medicine, we only treat pelvic pain and pelvic related conditions. All of our doctors are pelvic specialists, and more importantly, pelvic pain specialists. We treat a wide range of male pelvic pain and female pelvic pain conditions, including Hypertonic Pelvic Floor, Levator Ani Syndrome, Vulvar Pain and Vulvodynia, PGAD, Pudendal Nerve Entrapment, Fibromyalgia and Pelvic Pain, and many others.