My Philosophy of Treatment by Dr. E
I have been practicing Obstetrics and Gynecology for 37 years. Most of those years have been here in Bethlehem, Pennsylvania (except for a few years in Bangkok, Thailand for the US Army, and 5 years – 1995-2000 - in Las Cruces, New Mexico, working for an indigent based clinic).
As the medical partner for http://www.SecretSuffering.com, I would like to share my background with you and how my own practice as a specialist in chronic pelvic pain (CPP) has evolved.
Upon returning to Bethlehem, PA in 2000, I was asked to establish a non-surgical program for women with chronic pelvic pain for a hospital in Bethlehem. I had no idea at the time how rewarding an experience this was destined to become. I had always thought that the excitement and gratification I received during the years I spent delivering several thousand babies, and doing my best to care for the gynecological needs of women through their life cycles could never be matched … until I ventured into this new professional endeavor.
We developed an approach and a “model” for assessing, educating and treating women with the wide variety of painful symptoms known, in total, as Chronic Pelvic Pain (CPP). Many of our patients (close to 500 women and a handful of men) have benefited immeasurably and regained their health.
Guiding these patients, many of whom had suffered for years and even decades, back to health, made my newly created program an absolute pleasure to work in. It is my hope that I continue to help CPP sufferers for the remainder of my professional years.
The current health care system in America, as many of you realize, is “broken” in many ways and in need of incredibly intense reform. The primary incentives for physicians and other health care providers is to spend as little time with patients as possible, and carry out as many invasive tests and surgical procedures as they can. Consequently, most of the patients that I see in our program have had numerous procedures, surgeries and tests, and have seen many different specialists who have not been able to “fix” their painful symptoms. In many cases, patients are at their lowest point when we begin to see them.
For many years as a gynecologist, my “blinders” (and my thinking) were just as I describe above. I believed that the cause of female pelvic pain was limited primarily to endometriosis, ovarian cysts, pelvic infections, and pelvic adhesions. If those conditions were ruled out then the patient would be sent off to the urologist, GI doctor, low back specialist, family doctor, chiropractor, orthopedic doctor and finally even to the psychiatrist.
Through the program we developed, I learned that there were many other pathways to the pain. I became much more familiar with urinary bladder and lower bowel dysfunctions, because at least 80% of chronic pelvic pain is triggered by non-gynecologic functional disorders such as Irritable Bowel Syndrome (IBS) and Painful Bladder Syndrome/Interstitial Cystitis (PBS/IC). Consequently, we developed very specific treatment regimens for these conditions including specialized medications, dietary changes and bladder instillation treatments.
I had to learn many new concepts particularly about chronic pain in general and how it differs so much from the “acute pain model” that most physicians are trained to follow. In the pelvis, there are multiple “triggers” for pain, and the nervous system and muscular system which is quite complex in that region of the body is usually (and unfortunately) entirely ignored by many of the pelvic “specialists.”
We also discovered a common thread among women who complained of pelvic pain, no matter what the cause — 85 – 90 % also experience sexual pain or discomfort as the main contributor to their diminished quality of life. The impact of this sexual pain on their relationships and intimacy is therefore enormous. So we also deal with many of the conditions of the lower genital tract that diminish sexual pleasure and increase sexual pain such as vulvodynia, vulvar vestibulodynia, vaginismus, pelvic floor hypertonic dysfunction, and even clitoral pain and sensitivity.
As a member of the “International Pelvic Pain Society,” I have been privileged to participate in numerous national forums on chronic pain. Our model of care has been derived from a number of these sources. Therefore, in my practice, we believe strongly in integrative medicine. Along with the neurophysiology and myofascial pain issues, I needed to learn a great deal about other crucial modalities such as specialized pelvic floor physical therapy, yoga, acupuncture, therapeutic myofascial massage, diatetics, emotional counseling, trigger point therapies and other relaxation techniques, all of which are vital in dealing with chronic pain symptoms. Our program has become associated with a network of well-trained specialists in each of these fields. I am proud to say that our program has resulted in an increased quality of life for hundreds of women and restored intimacy to their relationships.