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# Arizona Center for Chronic Pelvic Pain: Arizona Center for Chronic Pelvic Pain (AZCCPP) is a comprehensive center for chronic pelvic pain treatment in women and men. Call AZCCPP, your trusted pelvic pain expert in Arizona, at 480 599-9682. Or email us at clinic@azccpp.com. 

## Sitemaps
[XML Sitemap](https://azccpp.com/sitemap_index.xml): Includes all crawlable and indexable pages.

## Posts
- [PGAD Persistent Genital Arousal Disorder](https://azccpp.com/pgad-persistent-genital-arousal-disorder/): Persistent Genital Arousal Disorder (PGAD) is a condition where people feel ongoing genital arousal that isn’t related to sexual activity or desire. It can happen to anyone and often leads to frustration, discomfort, and emotional stress. At AZCCPP, we want to make sure you feel understood and cared for.
- [Emboltherapy Treatment: Solution for Pelvic Vein Pressure](https://azccpp.com/emboltherapy-pelvic-vein-pressure/): In the early 2000s, embolotherapy became a recognized treatment option for pelvic vein pressure and pelvic congestion syndrome (PCS). This came about after studies revealed that it successfully reduced pelvic varicose vein-related chronic pain. Since then, Pelvic Vein Embolization (PVE) has been increasingly adopted as a minimally invasive alternative to surgical procedures, offering high success rates with minimal recovery time.
- [Best Hormonal Therapies for Irregular Periods and Menstrual Pain](https://azccpp.com/hormonal-therapies-irregular-periods-menstrual-pain/): Led by Dr. Michael Hibner, our expert pelvic pain doctor team specializes in hormonal therapies and pelvic pain treatment to restore balance and provide lasting relief.
- [Pelvic Congestion Syndrome: 10 Tips for Effective Management](https://azccpp.com/pelvic-congestion-syndrome-management/): Pelvic Congestion Syndrome (PCS) is a chronic condition that primarily affects women, causing chronic pelvic pain due to varicose veins in the pelvic region. Managing PCS involves a combination of lifestyle changes, medical treatments, and alternative therapies. Here are 10 tips for effectively managing PCS: 
- [Piriformis Syndrome | A Dive into Piriformis Syndrome and Its Management](https://azccpp.com/piriformis-syndrome/): Piriformis syndrome is a condition that can lead to persistent pain, numbness, and tingling sensations in the buttocks, radiating down to the legs. It occurs when the piriformis muscle in the buttocks near the top of the hip joint irritates or compresses the sciatic nerve. Here, we'll explore piriformis syndrome, beneficial exercises and stretches to alleviate symptoms, and exercises to avoid aggravating the condition.
- [Ovarian Cysts: Crucial Facts on Symptoms, Treatment, & More](https://azccpp.com/ovarian-cysts-symptoms-treatment-more/): At the Arizona Center for Chronic Pelvic Pain (AZCCPP), we specialize in diagnosing and treating conditions like ovarian cysts and chronic pelvic pain in women.
- [Endometriosis: Top 10 FAQs You Need to Know](https://azccpp.com/endometriosis-top-10-faqs-you-need-to-know/): Endometriosis is a pervasive but often overlooked condition affecting approximately 10% of women and girls of reproductive age worldwide, amounting to an estimated 190 million people. Despite its prevalence, it remains underdiagnosed and misunderstood, with women typically experiencing delays of 7-10 years before receiving a definitive diagnosis. For women in Arizona and beyond, endometriosis can cause a range of debilitating symptoms that impact physical, emotional, and social well-being.
- [A Physician’s Perspective on Pudendal Neuralgia](https://azccpp.com/chronic-pelvic-pain-perspective-on-pudendal-neuralgia/): Dr. Michael Hibner is an international expert on pudendal neuralgia and chronic pelvic pain. Dr. Hibner joins Holly Tanner to discuss his new exclusive course with H&W titled Pudendal Dysfunction: The Physician's Perspective.
- [Endometriosis and Its Connection to Ovarian Cysts: Expert Insights from AZCCPP](https://azccpp.com/endometriosis-connection-ovarian-cysts/): At the Arizona Center for Chronic Pelvic Pain (AZCCPP), we understand how debilitating chronic pelvic pain in women can be, especially when caused by conditions like endometriosis and ovarian cysts. Endometriosis, a condition where tissue similar to the uterine lining grows outside the uterus, often leads to the formation of painful ovarian cysts known as endometriomas.
- [Diagnosing Asymptomatic Inflammatory Prostatitis: Semen Analysis](https://azccpp.com/diagnosing-aip-semen-analysis-men-prostatitis/): Asymptomatic Inflammatory Prostatitis (AIP) represents a complex condition often diagnosed incidentally during evaluations for other urogenital disorders. While the absence of symptoms challenges its detection, a meticulous semen analysis offers significant insights into the inflammatory status of the prostate. This article explores the diagnostic value of semen analysis in detecting AIP, underlining its relevance in modern urological practice. 
- [Prostatitis | A Comprehensive Overview of Treatments and Distinctions](https://azccpp.com/prostatitis/): Prostatitis, a condition often heard of but seldom fully understood, predominantly affects the male population, specifically the prostate gland. This condition is characterized by inflammation or infection of the prostate gland and can significantly impact the quality of life. In this article, we explore the nuances of prostatitis, delve into the various treatment modalities available, and finally, draw distinctions between prostatitis and benign prostatic hyperplasia (BPH), a condition often confused with prostatitis due to the similarity in the affected region and some overlapping symptoms.
- [Diagnosing Asymptomatic Inflammatory Prostatitis: Prostate Biopsy](https://azccpp.com/diagnosing-aip-prostate-biopsy-men-prostatitis/): Prostatitis, an inflammation of the prostate gland, presents a unique challenge in the diagnosis and management of prostate-related conditions. In men with prostatitis, the need for accurate diagnosis becomes paramount, especially when symptoms overlap with other prostate conditions, such as prostate cancer. One of the most definitive diagnostic tools available is the prostate biopsy. This article delves into the intricate relationship between prostatitis and prostate biopsy, providing a comprehensive guide for men facing this procedure. 
- [On Men’s Health: Chronic Prostatitis or Pelvic Pain Syndrome](https://azccpp.com/chronic-prostatitis-pelvic-pain-syndrome/): Chronic Prostatitis and Pelvic Pain Syndrome (CP/CPPS) are complex and multifaceted conditions that significantly impact men’s health. Characterized by persistent pelvic pain and discomfort, these disorders can severely affect quality of life. This article provides an in-depth analysis of CP/CPPS, including its types, causes, diagnostic methods, and management strategies.
- [Interstitial Cystitis (BPS): Symptoms, Pelvic Floor & Care](https://azccpp.com/interstitial-cystitis/): Interstitial cystitis (bladder pain syndrome) is chronic bladder and pelvic pain, often with urgency. It commonly overlaps with pelvic floor spasm and pudendal neuralgia, which is why a pelvic pain center sees it—not only a urology clinic.
- [Diagnosing Asymptomatic Inflammatory Prostatitis: Prostate-Specific Antigen Testing (PSA Testing)](https://azccpp.com/diagnosing-aip-prostate-specific-antigen-testing-psa/): Prostate-specific antigen testing or PSA testing has long been utilized as a diagnostic tool in monitoring prostate health. For men with prostatitis, a condition characterized by inflammation of the prostate gland, PSA levels can be an essential marker in assessing the severity and progression of the disease. This article delves into the intricacies of PSA testing in the context of prostatitis, exploring its significance, interpretation, and implications for clinical management.
- [Pudendal Neuralgia Exercises: Do vs Avoid](https://azccpp.com/pudendal-neuralgia-exercises/): Pudendal neuralgia exercises should unload the nerve, not clamp down on the pelvic floor. This page outlines the general protocol: what to avoid, which stretches and nerve glides are usually used first, and when to stop and get examined.
- [Best Step-by-Step Pudendal Neuralgia Exercises for Men](https://azccpp.com/best-step-by-step-pudendal-neuralgia-exercises-for-men/): Pudendal neuralgia exercises for men are a topic you don't normally see because many people consider pelvic pain to be a problem only women experience(opens in new tab). However, research shows that up to 10% of men experience pelvic pain due to pelvic floor dysfunction at some point in their lives.
- [Diagnosing Asymptomatic Inflammatory Prostatitis: Digital Rectal Examination (DRE)](https://azccpp.com/diagnosing-aip-digital-rectal-examination-dre/): Prostatitis is an umbrella term for various disorders affecting the prostate gland, encompassing several distinct types, each with unique clinical features. The main forms of prostatitis include acute bacterial prostatitis, chronic bacterial prostatitis, chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), and asymptomatic inflammatory prostatitis. While symptoms can vary, common manifestations include pelvic pain, urinary difficulties, and sexual dysfunction.
- [On Men’s Health: What Is Asymptomatic Inflammatory Prostatitis](https://azccpp.com/asymptomatic-inflammatory-prostatitis/): Discover the hidden aspects of asymptomatic inflammatory prostatitis—how it’s detected, its potential health implications, and why monitoring prostate health is crucial, even in the absence of symptoms.
- [Pudendal Neuralgia Treatment: Innovative Options at AZCCPP](https://azccpp.com/pudendal-neuralgia-treatment/): If you're experiencing persistent pelvic pain, burning sensations, or discomfort during sitting, you may be dealing with pudendal neuralgia. In this guide, we'll cover everything you need to know about pudendal neuralgia treatment, from symptoms and diagnosis to conservative and surgical options. Our goal is to empower you with knowledge so you can make informed decisions about your care.
- [What Causes Vaginal Spasms?](https://azccpp.com/what-causes-vaginal-spasms-guide/): Vaginal spasms, also known as vaginal cramps or vaginismus, are a condition characterized by involuntary muscle spasms of the pelvic floor muscles, leading to discomfort or pain during vaginal penetration. Estimates suggest that approximately 1% to 7% of women experience vaginismus, though some studies indicate the prevalence may be as high as 17% due to underreporting.
- [Uterine Fibroids: Questions on Symptoms, Treatment, & More](https://azccpp.com/uterine-fibroids-symptoms-treatment/): Uterine fibroids, also known as leiomyomas or myomas, are benign tumors that develop within the muscular wall of the uterus. These growths are incredibly common, affecting many women, especially during their reproductive years. While they are typically not cancerous, fibroids can cause a range of symptoms and potential complications. 
- [Understanding Vaginal Spasms (Vaginismus): Top 10 FAQs](https://azccpp.com/vaginal-spasms-faqs/): Vaginal spasms, clinically known as vaginismus, represent a complex and often misunderstood condition. This involuntary tightening of the pelvic floor muscles, especially around the vaginal area, can cause pain, discomfort, and challenges with penetration. The condition can affect many areas of a woman’s life, including physical well-being, emotional health, relationships, and sexual function. To help shed light on this condition, here are the top 10 questions women often have about vaginal spasms and vaginismus.
- [Physiotherapy for Chronic Pelvic Pain: A Path to Lasting Relief (Empowering You to Reclaim Comfort and Control)](https://azccpp.com/physiotherapy-for-chronic-pelvic-pain-lasting-relief/): If you're searching for physiotherapy for chronic pelvic pain, you've found a proven, non-invasive path to relief. At AZCCPP, our pelvic health specialists target the root causes—tight muscles, nerve irritation, and movement imbalances—to help you move, live, and thrive without constant discomfort.
- [Vulvodynia: Symptoms, Causes & Treatment Options](https://azccpp.com/vulvodynia/): Vulvodynia is a chronic pain condition affecting the vulvar area in women, known for its potential to substantially impact the quality of life.
- [Understanding Pelvic Congestion Syndrome and the Role of Vein Embolization](https://azccpp.com/pelvic-congestion-syndrome-pcs-and-vein-embolization/): Pelvic congestion syndrome (PCS) is a chronic condition characterized by varicose veins in the pelvic region. It primarily affects women and can cause significant discomfort and pain. While various treatment options exist, vein embolization has emerged as a minimally invasive and effective approach to alleviating pelvic pressure and improving quality of life. 
- [Pelvic Congestion Syndrome in Women: 10 Common Questions Answered](https://azccpp.com/pelvic-congestion-syndrome-women-faqs/): Pelvic congestion syndrome (PCS), also known as pelvic venous insufficiency, is a frequently misunderstood and underdiagnosed condition affecting women. Characterized by chronic pelvic pain, PCS can significantly impact a woman's quality of life.  
- [Physical Therapy Guide to Pelvic Pain (Your Comprehensive Resource for Relief and Recovery)](https://azccpp.com/physical-therapy-guide-to-pelvic-pain-relief-recovery/): Are you in need of pelvic pain relief and recovery? Know that you need not suffer from pain. AZCCPP offers non-invasive solutions to treat your pelvic pain and get you back on your feet, pain free!
- [Hormone Treatments to Reduce Pelvic Vein Congestion: A Comprehensive Guide](https://azccpp.com/pelvic-vein-congestion-hormone-treatments-pvc/): Pelvic vein congestion (PVC) is a prevalent yet often underdiagnosed condition affecting women. Characterized by enlarged veins in the pelvic region, it can lead to chronic pelvic pain, discomfort during intercourse, and a range of other debilitating symptoms. While several treatment options exist, hormone therapy has emerged as a promising avenue for managing PVC and improving quality of life. In this comprehensive guide, we delve into the world of hormone treatments for PVC, exploring their mechanisms, benefits, risks, and considerations for optimal management. 
- [Pelvic Floor Physical Therapy: Your Key to Core Strength and Comfort (Expert Care for Bladder, Bowel, Sexual, and Pelvic Health at AZCCPP)](https://azccpp.com/pelvic-floor-physical-therapy-pelvic-health-azccpp/): Pelvic Floor Physical Therapy is a specialized, evidence-based treatment that strengthens, relaxes, and retrains the muscles supporting your bladder, bowel, and sexual health. At AZCCPP, our expert therapists deliver personalized care to resolve pain, leakage, and dysfunction—without surgery or long-term medication.
- [Pelvic Floor Spasms: Top Questions Women Are Scared to Ask](https://azccpp.com/pelvic-floor-spasms-questions-women-are-scared-to-ask/): Pelvic floor spasms, often called pelvic floor muscle spasms, are involuntary contractions of the muscles that support the pelvic organs. These spasms can lead to significant discomfort and disrupt daily activities. Despite their prevalence, many women hesitate to discuss this condition due to embarrassment or lack of information. This article aims to shed light on pelvic floor spasms, their causes, symptoms, and available treatments, particularly focusing on options in Arizona.
- [On Men’s Health: Understanding Chronic Bacterial Prostatitis](https://azccpp.com/understanding-chronic-bacterial-prostatitis/): Bacterial prostatitis is a result of a bacterial infection in the prostate gland, a vital component of the male reproductive system. Unlike acute bacterial prostatitis, which presents with sudden and severe symptoms, chronic bacterial prostatitis symptoms are often milder and can wax and wane over time, making diagnosis and management challenging. 
- [The Essential Role of Physical Therapy in Conquering Chronic Pelvic Pain (Targeted, Non-Invasive Relief at AZCCPP)](https://azccpp.com/role-of-physical-therapy-chronic-pelvic-pain/): Pelvic Floor Physical Therapy is your frontline defense against chronic pelvic pain (CPP). At AZCCPP, our pelvic health specialists use advanced manual techniques, movement re-education, and pain neuroscience to break the cycle of persistent discomfort—helping 70–85% of patients regain function and freedom.
- [Understanding Mesh-Related Pain: Expert Answers for Women ](https://azccpp.com/mesh-related-pain-expert-answers-for-women/): In the realm of women's health, mesh-related pain is a complex issue that demands comprehensive understanding and precise solutions. At the core of this matter lies many questions, often unanswered, that can leave individuals grappling with uncertainty and discomfort.
- [On Men’s Health: Understanding Acute Bacterial Prostatitis](https://azccpp.com/understanding-acute-bacterial-prostatitis/): Men's health is a topic that often takes a backseat in conversations, leaving many unaware of potential issues that may arise. One such concern is Acute Bacterial Prostatitis (ABP), an infection of the prostate gland. While relatively rare, understanding the symptoms, causes, and treatment options is crucial for maintaining optimal health. 
- [Understanding Pelvic Pain in Men: Causes, Symptoms & Solutions for Treatment and Full Recovery](https://azccpp.com/pelvic-pain-in-men-causes-symptoms-solutions-recovery/): Pelvic Pain in Men is a silent epidemic affecting 1 in 10 adult males—yet it’s rarely discussed. Whether it’s a dull ache after sitting, burning during urination, or sharp pain that derails intimacy, pelvic pain in men disrupts work, relationships, exercise, and self-confidence. The good news: specialized pelvic floor physical therapy resolves or significantly improves symptoms in 75–90% of cases when properly diagnosed and treated.

## Pages
- [Payment and Insurance Information](https://azccpp.com/payment-and-insurance-information/): Dear Patient
- [Regenerative Treatment](https://azccpp.com/regenerative-treatment/): Pudendal neuralgia, which is characterized by pain in the pudendal innervation area, can be triggered by various factors. Common causes include nerve compression due to spasming pelvic floor muscles, tight ligaments, scar tissue, or nerve inflammation without compression. Unfortunately, diagnostic tests are unable to differentiate between these mechanisms. Consequently, at AZCCPP, we use a stepwise approach to diagnosis and treatment. Initially, we address pelvic muscle spasms. If pelvic muscle spasms are identified during the examination, we recommend vaginal or rectal suppositories containing muscle relaxants, refer patients for pelvic floor physical therapy, and administer injections of botulinum toxin (Botox, Daxxify). If the muscles have relaxed but the pain persists, we then proceed to treat the pudendal nerves. The initial treatment involves injecting human placental mesenchymal stem cell exosomes (hpMSC-Exo), which we offer to all patients suspected of having nerve injury. If these treatments fail to provide relief, we turn to surgical decompression of the pudendal nerve (pudendal neurolysis) as a last resort.
- [Women’s Questionnaire](https://azccpp.com/womens-questionnaire/): Please do not fill in this field.
- [Form](https://azccpp.com/form/)
- [Michael Hibner Elected as AAGL Board of Directors Secretary Treasurer](https://azccpp.com/aagl-board-of-directors-secretary-treasurer/): Phoenix, AZ - 2022 - The Arizona Center for Chronic Pelvic Pain (AZCCPP) is pleased to announce the appointment of Dr. Michael Hibner, a distinguished member of our medical community, to the position of Secretary-Treasurer of the American Association of Gynecologic Laparoscopists (AAGL).
- [Questions that Need Answers](https://azccpp.com/questions-that-need-answers/): On May 26, 2023, I gave an interview for Pudendal Hope, a Facebook group for patients suffering from pudendal neuralgia and pelvic floor pain. This interview was initially scheduled for one hour, but after two and a half hours, there were still well over 100 questions that were not answered. This shows how patients with chronic pelvic pain are searching for answers, and that is why, in this interview I made a promise that I would answer all the remaining questions. This inspired me to launch a YouTube channel named "Questions that Need Answers with Dr. Michael Hibner." After I address all the remaining questions, I invite you to email your questions to qtna@azccpp.com.
- [Stretching Handouts](https://azccpp.com/stretching-handouts/): The piriformis is a muscle that connects from the sacrum or tailbone area out to the hip. This muscle can be particularly bothersome with pelvic pain or other pelvic symptoms because the sciatic nerve typically goes directly underneath this muscle and can wreak havoc. This handout is meant to give you options you can try to stretch this muscle. They are mostly ordered from easier to more advanced. with options laying down, sitting or otherwise. For the stretching and elongation of muscle tissue it is important to hold a mild to moderate stretch for at least 30 seconds. Therefore, hold each stretch for 30 or more seconds, and repeat about three times on each side, one to two times per day.
- [Patient-Friendly Pudendal Nerve Handout](https://azccpp.com/patient-friendly-pudendal-nerve-surgery-handout/): The more you understand your body and interventions, the better your outcomes will be. You have been selected for this pudendal nerve procedure by Dr. Hibner with the utmost care based on your symptoms and progress or lack of with other disciplines and treatments. This is done to ensure you are the most appropriate candidate and will have the greatest chances of success with this surgery!
- [Physical Therapy](https://azccpp.com/physical-therapy/): From Dr. Hibner himself, in regards to treating Pundendal Neuralgia, "What I tell patients is this. The number one thing for repetitive injury is to stop what you're doing. The number two thing is to choose physical therapy over anything else. By far the majority of patients are helped by appropriate pelvic floor physical therapy."
- [News & Resources](https://azccpp.com/news-resources/)
- [Pudendal Nerve Neuralgia](https://azccpp.com/pudendal-nerve-neuralgia/): In my practice, I define it as a pain located in the area of innervation of the pudendal nerve. Pudendal nerve entrapment is an impingement of the pudendal nerve caused by scar tissue, surgical materials, or mesh. Pudendal nerve entrapment is, therefore, one of the causes of pudendal nerve neuralgia, however other causes such as inflammation, spasm of the surrounding muscles, or other nerve diseases may also be a reason for pain.
- [Pages](https://azccpp.com/pages/)
- [Terms & Conditions](https://azccpp.com/terms-conditions/): This Practice website is offered to you conditioned on your acceptance without modification of the terms, conditions, and notices contained herein. Your use of this Practice Website constitutes your agreement to all such terms, conditions, and notices.
- [Privacy Statement](https://azccpp.com/privacy-statement/): We are committed to protecting your privacy and developing technology that gives you the most powerful and safe online experience. This Statement of Privacy applies to our Practice’s Website and governs data collection and usage. By using this website, you consent to the data practices described in this statement.
- [For Women](https://azccpp.com/for-women/): For women, internal reproductive organs such as fallopian tubes, uterus, and upper part of the vagina derive from Mullerian ducts. Mullerian ducts are structures present in the fetus. Those ducts during fetal development undergo multiple changes, including fusion of the left and right sides. 
- [For Men](https://azccpp.com/for-men/): Pudendal neuralgia is defined as pain in the area of innervation of the pudendal nerve. In men, areas affected can be penis, scrotum, perineum and rectum. Pudendal nerve entrapment is described as compression of the pudendal nerve from ligaments, scar tissue or surgical materials which leads to pudendal neuralgia. Some patients with pudendal nerve entrapment experience burning pain but others may have sensation of numbness. It may be present on one or both sides and some patients experience problems with erection and pain with ejaculation. Penile numbness is one of the frequent signs of pudendal neuralgia in men.
- [Contact Us](https://azccpp.com/contact/): AZCCPP offers comprehensive evaluation, personalized treatment plans, and compassionate care to help you find relief. To schedule an appointment at our Scottsdale office, call (480) 599-9682 or email clinic@azccpp.com.
- [Patients](https://azccpp.com/patients/): At the Arizona Center for Chronic Pelvic Pain (AZCCPP), we specialize in diagnosing and treating complex pelvic pain conditions with personalized, evidence-based care. If you're struggling with persistent pelvic pain, painful intercourse, bladder or bowel dysfunction, or conditions like endometriosis and ovarian cysts, our expert team is here to help. Don't let chronic pain disrupt your life-early intervention can make all the difference. Schedule a consultation today and take the first step toward relief. Call 480-599-9682 or visit www.azccpp.com to book your appointment!
- [Our Staff](https://azccpp.com/michael-hibner/): Michael Hibner was born in Warsaw, Poland, in an academic family but, interestingly, grew up in Nigeria, where his parents relocated for work. He returned to Poland to attend the Medical University of Warsaw, the medical school whose alumni included his mother and other family members.
- [About our Practice](https://azccpp.com/about-our-practice/): The Arizona Center for Chronic Pelvic Pain (AZCCPP) is a comprehensive treatment facility for chronic pelvic pain in both men and women.
- [Home](https://azccpp.com/): Dr. Michael Hibner is a native of Poland. He was born in Warsaw but spent big part of his childhood in Nigeria where his parents relocated for work. He then returned to Poland to attend Medical University of Warsaw, the same medical school that his mother, his aunt, two of his uncles and his cousin attended. In 1994 Dr. Hibner moved to United States and began residency in Obstetrics and Gynecology at Cook County Hospital in Chicago. While in residency he also studied a non-linear dynamics of fetal heart tones for which he later on he received PhD degree in bioengineering from his alma mater.
- [Under Construction](https://azccpp.com/under-construction/)

## Conditions
- [Prostatitis: A Comprehensive Overview of Treatments and Distinctions](https://azccpp.com/condition/prostatitis-treatments-distinctions/): Prostatitis, a complex condition affecting men, involves inflammation or infection of the prostate gland. This article delves into prostatitis treatments, shedding light on the distinctive nature of this ailment and addressing its connection to Pudendal Neuralgia. Understanding the interplay between prostatitis and pudendal neuralgia is crucial, considering the impact on discomfort, pain, urinary symptoms, and sexual dysfunction.
- [Vulvodynia | Comprehensive Guide of Symptoms & Treatments](https://azccpp.com/condition/vulvodynia-treatment/): Vulvodynia treatment remains a complex challenge due to the chronic and enigmatic nature of this condition, which impacts the vulvar area in women and significantly diminishes their quality of life.
- [Interstitial Cystitis (BPS): Symptoms, Pelvic Floor & Care](https://azccpp.com/condition/interstitial-cystitis-management/): Interstitial cystitis (bladder pain syndrome) is chronic bladder and pelvic pain, often with urgency. It commonly overlaps with pelvic floor spasm and pudendal neuralgia, which is why a pelvic pain center sees it—not only a urology clinic.
- [A Deep Dive Into Piriformis Syndrome Management](https://azccpp.com/condition/piriformis-syndrome-management/): Piriformis Syndrome management is no easy feat, but it is still doable. This syndrome is a commonly associated condition with Pudendal Neuralgia that can lead to persistent pain, numbness, and tingling sensations in the buttocks, radiating down to the legs.
- [Pudendal Nerve Block](https://azccpp.com/condition/pudendal-nerve-block/): A pudendal nerve block, commonly called a pudendal block, is a medical procedure used for pain management, primarily to alleviate nerve pain stemming from the pudendal nerve. This nerve provides sensation to the pelvic region, including the perineum, rectum, and genitals. In cases where there is nerve compression or damage, patients can experience debilitating neuropathic pain. This discomfort can manifest in various ways, including perineal or vaginal pain. It can be linked to conditions where the pelvic floor muscles exert excessive pressure on the nerve or other localized traumas. The pudendal block involves the injection of a local anaesthetic near the pudendal nerve, often using ultrasound guidance to ensure precision. The primary aim is to temporarily numb the nerve, thereby interrupting pain signals. This offers immediate pain control and provides valuable diagnostic insight: if the pain is alleviated post-injection, it reaffirms the pudendal nerve's role in the pain experienced by the patient.
- [Vaginal Spasms](https://azccpp.com/condition/vaginal-spasms/): Vaginal spasms, medically known as vaginismus, manifest as the involuntary contraction of the vaginal muscles, often leading to discomfort, vaginal pain, and difficulty or even an inability to engage in vaginal penetration, including sexual intercourse. This condition can be deeply distressing and can lead to a cycle of sexual pain and fear of further pain, complicating matters even further. Causes of vaginal spasms can range from physical conditions like vaginal dryness, often associated with vaginal atrophy, or conditions like vulvodynia, which results in chronic genital pain. In some instances, even routine medical procedures like a pap smear or a pelvic exam can become exceedingly painful due to muscle contractions. It's also noteworthy that conditions such as pelvic inflammatory disease or a disturbance to the pudendal nerve, which caters to the pelvic area, might contribute to heightened sensitivity and muscle spasms.
- [Pudendal Nerve Entrapment](https://azccpp.com/condition/pudendal-nerve-entrapment/): Pudendal Nerve Entrapment, a condition that affects the pudendal nerve in the pelvic region, can produce chronic pain and interfere with daily activities. This post aims to provide valuable insights into understanding the condition, recognizing its symptoms, diagnosing and treating it, implementing lifestyle modifications, and adopting preventative measures for long-term management.
- [Ovarian Remnant Syndrome | Understanding The Silent Struggle](https://azccpp.com/condition/ovarian-remnant-syndrome/): Ovarian Remnant Syndrome (ORS) is a rare medical disorder that develops when ovarian tissue is left behind following ovarian surgery, such as having undergone oophorectomy. (complete removal of one or both ovaries). This can result in several symptoms, such as chronic pelvic pain, menstrual abnormalities, and infertility. ORS might be difficult to identify because its symptoms can resemble those of other gynecological conditions.
- [Pain with Ovulation](https://azccpp.com/condition/pain-with-ovulation/): Pain with ovulation is called mittelschmerz. It is experienced by about 20% of women in some or all cycles. It occurs roughly halfway between menstrual cycles. It is usually sharp seven and located in the lower abdomen either on the left or right side. It is unknown why this condition happens and usually treated with nonsteroidal anti-inflammatory medications.
- [Rectovaginal Fistula: Symptoms, Causes & Repair](https://azccpp.com/condition/rectovaginal-fistulas/): A genitourinary fistula is a permanent opening between the bladder and the vagina, the ureter and the vagina, or the rectum and the vagina. Those fistulas may result from traumatic childbirth, pelvic surgery, trauma or radiation therapy. The symptom of the fistula is loss of urine (vesicovaginal fistula) or stool (rectovaginal fistula) from the vagina.
- [Müllerian Anomalies](https://azccpp.com/condition/mullerian-anomalies/): Mullerian anomalies can affect up to four percent of the female population. The anomaly is considered a 'hereditary disorder'; this indicates that this complication occurs during fetal development and is present during childbirth. As an embryo forms, the two paired Mullerian ducts will develop into the female genital tract, including the fallopian tube, uterus, cervix, and upper two-thirds of the vagina. 
- [Ovarian Cysts](https://azccpp.com/condition/ovarian-cysts/): Ovarian cysts are a common gynecological condition that can affect women of all ages, particularly those of reproductive age. While many cysts develop as a normal part of the menstrual cycle and go unnoticed, others can cause discomfort, hormonal imbalances, or complications that require medical attention.
- [Uterine Fibroids: Symptoms & Treatment](https://azccpp.com/condition/uterine-fibroids/): Uterine fibroids, medically called leiomyomas, are benign tumors of the uterus. They may range in size from microscopic to as large as a basketball or bigger. Approximately 20 to 25% of women of reproductive age are affected by fibroids, and this incidence may go up to 40% in women who are older than 40. Patients who had their first menstrual period at a younger age or with later-than-normal menopause are at higher risk for fibroids. Fibroid tumors are the most common in African American women and the least common in women of Asian descent. They are also more common in women who have a first-degree relative with fibroids.
- [After Childbirth](https://azccpp.com/condition/after-childbirth/): Childbirth is one of the happiest moments in any woman’s life. Unfortunately, some patients may develop pelvic pain after delivery. In most cases this pain goes away within few weeks but in some it remains for much longer. There are multiple causes of pelvic pain after childbirth but most commonly it is of musculoskeletal origin. Some patients, especially after vaginal delivery, may develop spasm of pelvic floor muscles. This is more likely to happen in patients who had a big baby, had a procedure to help deliver the baby (vacuum or forceps) or had a big episiotomy or tear. In a small percentage of those patients, pain may be caused by nerve injury, specifically pudendal nerve or one of its branches. It is hard to initially distinguish between nerve and muscle injury because symptoms are similar, and diagnosis requires a physician who is familiar with pelvic floor disorders and nerve disorders to make that diagnosis.
- [First Menstrual Period](https://azccpp.com/condition/first-menstrual-period/): It is estimated that up to 90% of women experience pain with onset of menstrual periods (menarche). It is called primary dysmenorrhea and by itself it does not mean any specific disease. With time and use of non-steroidal anti-inflammatory (NSAID’s) medications or oral contraceptives as well as healthy lifestyle, menstrual period pain in most of the patients improves. If this pain continues for 12 months after menarche, then it is called secondary dysmenorrhea. This ongoing pain with increases the chance of a specific condition causing pain. It is estimated that approximately 70% of patients with secondary dysmenorrhea have endometriosis. Diagnosis of endometriosis can only be done by the surgical procedure (laparoscopy, robotic procedure) and it cannot be reached by any other test. Physician may have a high suspicion of endometriosis but unless it is surgically proven, it is only a suspicion. It is especially important that this surgery is done by a provider who is familiar with diagnosis, treatment endometriosis and minimally invasive surgery.
- [Psychological Trauma](https://azccpp.com/condition/psychological-trauma/): Psychological traumatic event may be devastating to any patient at the time when it happens, but a lot of patients develop lasting effects of such a trauma. They are seen in women and men who are survivors of sexual violence, domestic violence, who have lived through sickness or death of a close relative or friend and many other traumatizing situations. It may happen in people who have highly stressful jobs or who have survived an accident, even without any trauma to the pelvis. In children it may happen during the divorce of their parents.
- [After Surgery](https://azccpp.com/condition/after-surgery/): Patients undergo surgery with hope of treating the existing problem, so when the pain develops after the procedure, it is very disheartening even if the original problem was successfully addressed. This is even more complicated when patient had surgery to help with existing pain and ends up with the pain that is more severe than the pain she went in.
- [After Accident](https://azccpp.com/condition/after-accident/): Motor vehicle accident or any other accident is very traumatic and painful event. It is even more traumatizing when pain remains after healing ends. Some patients may develop persistent pelvic pain after a traumatic event even if there was no direct trauma to the pelvis. Patients who develop pain after accident often develop spasm of the pelvic floor muscles. Without direct trauma this spasm develops when patients are bracing for impact. Pelvic floor muscle spasm may be appreciated on the pelvic exam by a provider knowledgeable in this condition. Alternatively, patients with pelvic pain after accident may also suffer from compression or injury of one of the pelvic nerves. If pain is located in the vulva, vagina, penis, scrotum, perineum or rectum it may be caused by injury to the pudendal nerve. If that pain is in the lower abdominal or groin it may be caused by injury to ilioinguinal or genitofemoral nerve.
- [Back Pain with Menstruation](https://azccpp.com/condition/back-pain-with-menstruation/): Women understand the difficulty of enduring menstrual back pain every month. It is the type of pain that can turn even the most optimistic diva into a grumpy older woman.
- [Pain with Physical Activity](https://azccpp.com/condition/pain-with-physical-activity/): Pelvic pain with physical activity is usually caused by spasm of pelvic floor muscles. It may also be caused by abnormalities in hip joints and bones which is outside the scope of my practice.
- [Pain with Intercourse/Arousal](https://azccpp.com/condition/pain-with-intercourse-arousal/): Pain with intercourse in the rear entry (“doggy”) position is common in patients with interstitial cystitis/bladder pain syndrome.
- [Pain with Urination](https://azccpp.com/condition/pain-with-urination/): Pain with urination is a common symptom seen in many different conditions. Occasionally all of us experience it when we have a urinary tract infection. It becomes problematic when it is chronic and happens every time we go to the bathroom. It may range from mild discomfort to severe pain. It is very important to distinguish between pain when the bladder gets full, pain during urination, and pain at the end of urination.
- [Pain with Standing](https://azccpp.com/condition/pain-with-standing/): Most of the patients with pelvic pain feel better when they are standing unless it is a standing for prolonged time.
- [Pain with Sitting](https://azccpp.com/condition/pain-with-sitting/): Pain with sitting may be very debilitating since it often prevents patients from working (sitting at the desk) and participating in daily social activities (sitting to have a meal, travelling, going to the movies etc.) It may range from mild discomfort to severe pain preventing patient from sitting at all. Some patients find sitting on the doughnut cushion beneficial, others use zero gravity chairs or kneeling chairs and some patients do not set at all. They arranged their workspace using various types of standing desks.
- [Adhesions](https://azccpp.com/condition/adhesions/): Adhesions are the scar tissue which forms in the abdominal cavity and pelvis between the loops of the bowel, the bowel and the walls of the pelvis, the pelvic organs and the content of the abdomen. They may range from few areas of fine scar to the very dense obliterated abdominal and pelvic cavity. Adhesions form as a result infections, trauma or previous surgeries. Patients with intra-abdominal and pelvic adhesions generally experience sharp pain which may be more severe with physical activity, rapid movement, especially turning from side to side at night.
- [Pelvic Congestion Syndrome](https://azccpp.com/condition/pelvic-congestion/): When blood pools in the pelvic vein or ovarian vein, it may result in enlarged veins, causing pain, tenderness, and redness. Varicose veins usually develop in the legs, calves, and feet, but can also occur in the pelvic region, leading to pelvic congestion syndrome.
- [Bladder Pain / Interstitial cystitis](https://azccpp.com/condition/bladder-pain/): Interstitial cystitis (bladder pain syndrome) is a condition which is characterized by the bladder pain during the filling phase. Patients usually complain of pain as the bladder gets full and because of that they urinate frequently to avoid pain sensation. Patients also complain of urgency (got to go sensation) and getting up at night multiple times to urinate. There is always pain with intercourse especially in positions where bladder is directly irritated by the partner’s penis. Patients often have pain outside the bladder, in the vulva, lower back and abdomen. Certain foods and drinks, especially acidic, spicy, containing coughing or alcohol are known to trigger pain and urgency in patients with bladder pain syndrome. Drinks include coffee and tea (both caffeinated and decaffeinated), soda, alcohol, citrus juices, and cranberry juice. Fruits which acidified urine are lemons, limes, oranges, grapefruit, pineapple, kiwi fruit as well as vegetables such as chili peppers, onions, sauerkraut, tomato products and pickles worsen interstitial cystitis symptoms. Processed cheese, dark chocolate and yogurt are also known to aggravate the bladder.
- [Pelvic Floor Spasms](https://azccpp.com/condition/pelvic-floor-spasms/): Pelvic floor spasms, a subset of the broader condition known as pelvic floor dysfunction, refer to the involuntary and persistent contraction of the muscles located in the pelvic region. The pelvic floor musculature, comprising a complex web of muscles, ligaments, and connective tissue, plays a pivotal role in supporting the bladder, rectum, and other pelvic organs. When these muscles undergo undue tension or muscle spasms, it can lead to a variety of uncomfortable and sometimes painful symptoms. Patients might experience challenges during sexual intercourse due to muscle tension, leading to compromised sexual health and function. Additionally, an overactive bladder, urinary incontinence, and even symptoms similar to irritable bowel syndrome can manifest when the pelvic floor muscles are in persistent spasm. As these muscles are closely associated with the ani muscle, any dysfunction in this region can severely impact daily activities and overall well-being.
- [Mesh Related Pain](https://azccpp.com/condition/mesh-related-pain/): With aging, childbirth and changes in hormonal status over 50% of women will develop urinary incontinence and prolapse. Those diseases of pelvic floor may be treated non-surgically and surgically. For many years pelvic floor surgeries surgeries were preformed using patients own tissue (native tissue repair), but in 1996 first polypropylene pelvic mesh for treatment of stress urinary incontinence was introduced. It quickly replaced traditional surgical procedures and mesh based procedures became the mainstream treatment for stress urinary incontinence in women. In 2004, mesh for treatment of pelvic organ prolapse was introduced and soon after FDA started receiving information of patients who have developed problems after this surgery. In 2008 FDA issued the first warning regarding the dangers of pelvic mesh; in 2016 pelvic mesh was reclassified as type class III device requiring extensive research before brining devices to the market and in 2019 polypropylene mesh for pelvic organ prolapse was taken off the marked altogether. Polypropylene mesh used in retropubic and transobturator slings continues to be used for treatment of stress urinary incontinence.
- [Endometriosis](https://azccpp.com/condition/endometriosis/): Endometriosis is a condition in which the tissue that normally is present inside the cavity of the uterus, called endometrium, starts growing on the pelvic walls, ovaries, fallopian tubes, bladder, bowels and occasionally pelvic nerves. Despite extensive research it is unclear how patients get endometriosis. There are multiple theories attempting to explain the etiology of this disease. One of the most popular, called Sampson’s theory, states that endometrial cells travel to the pelvis through the fallopian tubes with menstrual blood. Those cells then implant on the pelvic organs, ovaries, fallopian tubes, bowel, bladder and pelvic side walls. The second theory called Myers theory of coelomic metaplasia states that cells that have a potential of becoming endometriosis are already present in the peritoneal lining of the pelvis. Those cells become activated due to environmental or hormonal factors then turn into endometriosis. Unfortunately, neither one of those theories fully explains all the cases of this disease which means that endometriosis may form in several different pathways (may be multifactorial).
- [Pudendal Nerve Block | Pudendal Neuralgia in Men](https://azccpp.com/condition/pudendal-nerve-block-men/): Pudendal neuralgia is defined as pain in the area of innervation of the pudendal nerve. In men, areas affected can be the penis, scrotum, perineum, and rectum. Pudendal nerve entrapment is described as compression of the pudendal nerve from ligaments, scar tissue, or surgical materials which leads to pudendal neuralgia. Some patients with pudendal nerve entrapment experience burning pain but others may have the sensation of numbness. It may be present on one or both sides and some patients experience problems with erection and pain with ejaculation. Penile numbness is one of the frequent signs of pudendal neuralgia in men.
- [Pudendal Neuralgia](https://azccpp.com/condition/pudendal-neuralgia/): Pudendal neuralgia is a condition that affects the pudendal nerve, which transmits sensory information from the perineal region to the brain. People who experience pudendal neuralgia often describe it as a burning, shooting, or stabbing pain in the pelvic region.