March 3, 2021: One year, 7 physical therapists, and 12 doctors later, I have been diagnosed with…read morecongenital hip dysplasia, cam impingement, and they also found labral separation. It is believed that my legs were pulled in the position they had me during the botox procedure causing further hip pain. It is unfortunate that I have been treating my symptoms in the wrong order as many of my symptoms did not manifest until the day I had my procedure at Maze Clinic. I am still having moderate to significant pain in my groin, lower abdomen, lower back, and have consistent vulvodynia and pudendal neuralgia symptoms as well SI joint inflammation consistent with sacroiliitis/degenerative change. All of these symptoms began immediately after having the botox procedure here with the aggressive dilation.
May 2, 2022: I recently had stage IV endometriosis (adhesions, lesions, and cysts) excised in addition to having two PAOs where my hip dysplasia, impingement, and chondral labral separation, and SI joint inflammation were also causing significant pain. The endometriosis was everywhere, specifically behind the rectovaginal area, and most likely present when I had this procedure as well because I had debilitating dysmenorrhea that was overlooked. Endometriosis can cause deep dyspareunia, superficial dyspareunia, vulvodynia symptoms, hypertonic pelvic floor and more. It's just unfortunate that none of these were diagnosed or appeared earlier prior to doing this procedure. This is a common problem as many people face dismissal and are misdiagnosed over and over. I was told by many physicians and physical therapists including this place before this treatment that I just needed the "extra push." My vaginismus/hypertonicity is just a symptom compared to everything else. I also most likely have congenital neuroproliferative vestibulodynia - overgrowth of nerve endings at the vulvar vestibule - which is often mistaken for vaginismus for many patients.
There is a tremendous lack of knowledge/literature in the relationship between hip abnormalities and pelvic floor dysfunction. Hip dysplasia and/or impingement can lead to hypertonic pelvic floor and labral tears which can cause pelvic pain, SI joint inflammation, and symptoms that mimic pudendal neuralgia/vulvodynia and bladder urgency. Most pelvic floor PT exercises STRETCH and RELAX the muscles surrounding the hip, which is actually the OPPOSITE of what you need to do with hip abnormalities (dysplasia and impingement) since it can cause further damage and exacerbate pain symptoms.
The bottom line is that I needed real surgical interventions - 3 SURGERIES with leading surgeons before I could even come close to treating the sexual dysfunction and hypertonicity. No amount of dilation or botox would have helped any of this. My hips, buttocks, and lower back have little to no pain anymore and strengthening has had the best benefit for me.
To both patients and providers, attend an ISSWSH annual meeting or course to learn more about sexual health and stay up to date with the recent literature. Pelvic floor dysfunction can have many causes and misdiagnoses are common. If you are someone with a long history of pelvic pain, tightness, and the pain exists not just internally there may be something else at play. Also, if pelvic floor PT doesn't help or makes things worse, please go to another specialist and/or have a sacrum, pelvis, lumbar spine, and hip MRI/CT scan first. Please consider hip abnormalities, endometriosis, SI joint dysfunction, and vestibulodynia, and screen your patients for lower back, lower abdomen, and hip pain too.
