Re: Deep Tissue Vag Massage (was: My Type of Vulvodynia)

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Joyce, Dee sent this out some time ago and I kept it. Page down and you'll see a description on vaginal massage. I deleted the pictures of the pelvic floor. If you want those, post to Dee and ask her to send out. Hope this helps. Kathy DR. BARBARA REED U. of Mich ob/gyne Anatomy and innervation of the pelvic floor: The evaluation of pelvic floor symptomatology and the conceptualization of the potential anatomical correlates of the pattern of symptoms and signs present are aided by an understanding of the anatomy of the pelvic floor and the innervation to the various portions of the area. Superficially, the pelvic floor consists of the labia majora and labia minora -- both covered with squamous epithelium. Below the epithelium, the labia majora consist of subcutaneous fat, and deep to this is the superficial perineal fascia (a continuation of the anterior abdominal wall), and the deep (inferior) perineal fascia. The labia minora, in contrast, contain no fat. The paired paraurethral ducts (duct of Skene) open on either sides of the urethral orifice. Lesser vestibular glands, with orifices of microscopic size, open into the vestibule, and on each side of the vagina is the opening of the duct of the greater vestibular gland. Underlying the superficial tissues are the superficial muscles of the pelvic floor: the superficial transverse perineal muscles, the paired ischiocavernosus muscles, and the bulbocavernosus muscles that in turn cover the vestibular bulbs and the greater vestibular glands.

Deep to the pelvic floor musculature lie the erectile tissue and glands, consisting of the vestibular bulbs and greater vestibular glands and the crura of the clitoris. Innervation to the superficial perineal tissues is primarily innervated by branches of the pudendal nerves, first to the perineal muscles, and then to the posterior half of labia majora, and the labia minora and vestibule from smaller branches called "posterior labial nerves." A small portion of the lateral pelvic floor receives innervation from the perineal branches of the posterior femoral cutaneous nerves. The innervation to these superficial tissues originates in the sacral plexus -- usually from S2 and S3 for the posterior femeral cutaneous nerves, and either from S2 and S3 or from S2, 3, and 4 for the pudendal nerve -- these nerves contain parasympathetic, splanchnic and sympathetic fibers. In contrast, the innervation to the anterior half of the

labial majora and the mons pubis is typically from the anterior labial nerves -- branches of the ilioinguinal and the genitofemoral nerves -- both of which are branches of the lumbar plexus, and the space between the anus and coccyx originates in the 5th sacral and coccygeal nerves. Both of these areas might therefore have diagnostic localization discriminating value. The afferent innervation below the pectinate line in the anus (approx 2 cm. from the anal opening) is from somatic nerve fibers in the pudendal nerve, thus having similar origin to that of the pelvic floor muscles and superficial tissues. "Referred pain from the bulbocavernosus and levator vaginae portion of the levator ani is typically felt in the vaginal and/or perineal area, and from the ischiocavernosus muscles to the perineal region in general. " The innervation to the pelvic organs is distinctly different in origin from that of

the pelvic floor. The pelvic organs (uterus, ovaries, etc.) are innervated via the superior hypogastric and aortic plexuses, as opposed to the pelvic or inferior hypogastric plexus innervating the pelvic floor muscles. This suggests comparison of the vulvodynia group to a chronic pelvic pain group of patients is a reasonable way to differentiate two pain populations who may have similar psychological issues related to having pain that may disrupt sexual functioning, but who differ in etiology and source of painful stimuli. Innervation to the bladder, due to its common embryologic origin with the pelvic floor tissues, has innervation derived from the inferior hypogastric plexus, providing an anatomical correlate to support a relationship between interstitial cystitis and vulvodynia . <===========================================================>4. PELVIC FLOOR INJURIES AFTER CHILDBIRTH http://healthorbit.ca/NewsDetail.asp?opt=1 & nltid=104160804 ================================================== 5.http://seafish.freeyellow.com/vaginas.html This is a good one for deep tissue vaginal massage you can do yourself, (forget that it talks about pregnant women as it can work for all of us) ( OOPS, URL IS defunct, so I put the article below) Deep Tissue Vaginal Massage Deep Tissue Vaginal Massage - Sound weird? Well, as a massage therapist I do deep tissue massage all the time to relieve chronic pain, and it is very effective everywhere else, so why not DOWN THERE? Some guide lines: Don't use this before any tears or episiotomies have healed - you could reopen them, and that is very serious.

It is best to do this massage for about 10 minutes every evening, as opposed to a marathon session which will leave you sore and unwilling to try it again. Don't do more than is comfortable - every little bit helps, so just take it slowly! Its not as hard as it sounds - deep tissue actually isn't deep, its just a phrase that referrs to a type of massage that works on connective tissue. CT is where "body memories" are stored, including pain, trigger points and repressed memories. But you don't need to know that, or any other fancy massage stuff:) Just do this: Start by making a comfortable space - bed with pillows, or squatting on a soft carpet make sure your hands are washed use some lubricating gel, or olive oil - aloe vera gel is great because its soothing, but any lubricant will work Start by gently lubricating the outside of your vagina generously - you don't want any friction. Now, gently put a finger just inside your vagina

and squeeze it with the kegel exercises you remember so well from pregnancy. Pay attention to the feel of that ring of muscle - if you had an episiotomy, that was what was cut. If you had skid marks, the trigger points (painful spots) may be more shallow, in the skin of the vagina. Now very gently grab that ring of muscle (while its relaxed) between your thumb and index finger, and squeeze it. Pick a side and start, working your way all the way from front to back, and back around to front on the other side. In doing this, you have probably located every single painful spot. Good! If you know where they are exactly, you can solve them! Do this a few times until the muscle feels loose and relaxed, go easy on the sore parts - if your epi scar is really sore/stiff just massage to either side of it. It will still help. Feel for any little knots - either in the skin or in the muscle deep. These little knots are trigger

points, and probably you've already noticed that when you push on them you get a familiar pain. Those knots are where you want to work!Once the ring of muscle is relaxed and you are comfortable pick one of the least tender knots and put direct pressure on it with the ball of your thumb for about one minute. If that is tolerable, then pick another and do the same.Keep going until you have addressed all the trigger points you can find that aren't too painful to deal with. Again, if your epi scar is too sore to touch, just work as close as you can, it will still help. Okay, last part: Using the ball of your thumb and starting at the front of the ring, apply steady pressure to the ring of muscle and slooooowly start to slide around the ring. Keep the pressure steady and push deeply into the muscle from the center of the ring out. It should take a couple of minutes to go all the way around if you're going slow enough. Now, the first part of the massage is

to get blood flowing to your pelvic floor so the muscles will get relaxed, and to introduce your hands and vagina to eachother. The direct pressure on trigger points is to change the pain message they send to your brain - to get it all out, as it were. The last part is to break down scar tissue that might be keeping your vagina from relaxing fully to allow penetration without pain. When there are trigger points in an epi scar, address them once the scar is no longer painful to touch and go slowly - a couple of minutes a night. Don't over do it, or you will be unwilling to keep going the next night!A final note, occasionally a woman will have a rigid, hard vagina post partum - while this condition is not really addressed in western medicine (they just advise you to wait) it is easily treatable in Chinese medicine. Find a Chinese herbalist/acupuncturist to treat you for Liver Blood Deficiency - the rigidity is caused by a lack of blood in the

liver meridian - no blood to make the tissue moist and soft. From the horses mouth of an acupuncture student <==========================================================> 5. Here are some other links I collected for Levitor Ani.. http://link.springer.de/search.htm You may have to join. Type in Levator Ani in the search area, several abstracts there. http://www.vh.org/Providers/Textbooks/pelvis/muscle.html <--------- for an excellent technical one, text & picture, (just click any of the little boxes for more information. Compiled by Dee Troll DTroll@... *****END OF MESSAGE/REMOVE WHEN REPLYING*****http://groups.yahoo.com/group/VulvarDisordersto search our archive or view our files.***