Are you a woman dealing with pelvic pain? Do you experience it during intercourse? Does it hurt to pee or poop? Do you have pain inside or outside your vaginal area? Or lower back? Maybe your hips? Have you sought relief through pelvic floor physical therapy and medications, but so far, no luck? Then, trigger point injections may be a great evidence-based treatment option for you.

Below, Dr. Angel Marie Johnson, Director of our Women's Health Centers, discusses pelvic pain, trigger point injections, and how she makes patients comfortable during the procedure.

As with all content on Greater Boston Urology's blog, the following information is educational in nature, not medical advice. Always talk to your physician about your specific health care questions and conditions.

First, let's discuss pelvic pain. What do women need to keep in mind when it comes to getting an accurate diagnosis?

DR. JOHNSON: Pelvic pain is incredibly complex. A variety of muscles exist—both internal and external to the pelvis—that can cause pain in places like the vagina, the abdomen, the lower back, even the hips. When I see patients experiencing pelvic pain, my job is to clarify and understand where the pain is coming from.

A patient's symptoms will offer me clues. For example, if a woman can't insert a tampon comfortably or can't have intercourse comfortably, this alerts me that their pelvic muscles may be too tight. Or if they're experiencing hesitancy when they urinate, meaning they have the urge to pee, but they can't go immediately when they sit on the toilet or it takes them a while to go—again, this would suggest that their pelvic muscles are too tight or are not functioning properly. Because your pelvic muscles need to relax when you empty your bladder and bowels and stretch during sexual intercourse.

Some symptoms might even seem counterintuitive to the patient, at first. For example, patients who have jaw pain or who get migraines from tight jaw muscles often have tight pelvic floor muscles, too.

Bottom line: If you're experiencing pain in the pelvis area—particularly if your health care provider hasn't been able to identify the source or provide relief—seeing a pelvic health expert like me is a smart move, because we know the many signs and symptoms. We can accurately diagnose and treat pelvic pain. We may not be able to cure your pain. My goal is for women to live a life beyond the limits of pain.

What treatment options exist for pelvic pain in women?

DR. JOHNSON: First-line treatment is pelvic floor physical therapy. This involves learning different stretches, movements, and breathing techniques that will train the pelvic floor muscles to relax on their own. 

If pelvic floor physical therapy doesn't work, we'll try medications and ointments to help relax the muscles. If the medications don't work, trigger point injections are another option.

Discuss trigger point injections for pelvic pain. What happens during this procedure?

DR. JOHNSON: Trigger point injections involve injecting medication into the pelvic floor muscles through the vagina. The procedure takes place in my office, and the patients are awake and comfortable. I start the procedure by administering a nerve block. The nerve block makes patients comfortable—they won't feel the injections.

From there, I do the trigger point injections into the different pelvic muscles. The total procedure takes about 20 minutes with a potential benefit that can range from a few hours up to three months.

How long will patients experience relief?

DR. JOHNSON: It depends on the patient. Some patients might experience relief for three months or so. At that time, they'd come in again. For others, the trigger point injections might provide enough relief so that patients can tolerate pelvic floor physical therapy, which will then help retrain the muscles for longer term relief.

Does insurance typically cover trigger point injections for pelvic pain?

DR. JOHNSON: Yes, most insurance will cover it.

Is there anything else you want to mention?

DR. JOHNSON: I always tell my patients, 'Your quality of life matters. If you're in pain, talk to someone like me.' Treatment options do exist. Let me help.

Thanks, Dr. Johnson!

If you're a woman in the greater Boston area who is dealing with pelvic pain, consider making an appointment with Dr. Johnson to discuss your options. Your quality of life matters. Let us help!