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VAGINISMUS: is not a psychological problem. When these women are physically examined they are usually found to have laxity of ligaments of one of the sacroiliac joints. Pain generation from this joint subluxation radiates to the mid-pelvis. https://twitter.com/auspainsoc/status/1326373613201657857
There are 16 clinical examinations that physicians can do in the exam room to detect sacroiliac joint subluxation chronic pain disorder syndrome, but most physicians are ignorant of these examinations.
Some of the Signs are: Forward Flexion Test, Fortin Sign, Gillette Sign, Gaeslen’s Sign, Sacral Shear, Pelvic Compression, Thigh Thrust, Active Straight Leg, & the Badgley Book Sign. Another is to have the patient hop up and down on one leg to arouse ipsilateral buttock pain.
When a woman assumes the supine position with thighs flexed and abducted & as the male weight forces the legs apart, the biomechanical forces force the sacroiliac joint to sublux if the joint ligaments are lax.
Unconscious response of female pelvis is widespread muscle spasm in pelvic girdle; muscles contract & splint in attempt to stabilize the joint. Nature abhors loose joints, wherein ligaments are stretched & neutral anatomical lengths are exceeded; very painful events: vaginismus.
Women with hypermobile ligament tissue variations (est. 15%) are prone to develop permanent chronic sacroiliac joint ligament injuries from childbirths, slips and falls, & even from seemingly menial lifting events.
Women with lose sacroiliac joints commonly experience sciatica & restless non-refreshing sleep. No matter what posture pelvic girdle is placed against sleep surface, ground surface forces transmit pelvic ring to loosest joint, stretching it & arousing pain in stretched ligaments.
Another consequence of an unstable pelvis is a thoracolumbar spine given to scoliosis when upright; to maintain a medial center of gravity of the upright body tower. This is common in women with Hypermobility & is a “functional” scoliosis that dissipates when person is reclined.
Problem with a functional scoliosis is that it induces shoulder girdle asymmetry that leads to a slightly tilted head and crossed muscle syndromes (one side hypertrophic from chronic excess weight bearing) in neck, shoulders, and in muscles supporting the spine.
In hypermobile women, crossed muscle syndromes cause widespread chronic muscle spasms & entheses known as the Fibromyalgia trigger points, & these muscle spasms evoke widespread subluxation of body joints (including vertebrae).
Subluxing joints are given to impingement of the autonomic nerve system, which closely approximates the skeletal system. Impinged autonomic nerves evoke a multitude of dysautonomias, which are the hallmarks of Fibromyalgia.
Dysautonomias are known as Migraines, TMJ, TOS, Panic Attacks, Gastroparesis, IBS (both d & c), Interstitial Cystitis, & Dysmenorrhea. I speculate that Endometriosis, IBD (Crohn’s & UC), & CRPS are advanced disorders & consequences of long-term & entrenched dysautonomias.
Fibromyalgia is not one disorder or disease. It is a true Super-Syndrome. One problem with recognition of the causes of Fibromyalgia is that it has multifactorial causes. It manifests variously in different suffers.
Another characteristic that confounds recognition of the etiologies of Fibromyalgia is that the evolution of the tissue disorders & physiological changes occur over months and years; beyond the awareness of most doctors.
Other factors that obscure the etiologic relationships of Fibromyalgia are that the attendant subluxations, muscle spasms, & autonomic neural impingements are unable to be objectively demonstrated with imaging & electrodiagnostic studies.
Surely, there are blood studies (Substance P, cytokines, etc.) & functional MRI studies that are abnormal in Fibromyalgia sufferers. But no scientist can dispute that these abnormalities are not effects, nor can they scientifically assert that these measured functions are causal.
The most scientific way to study & prove etiologies of Fibromyalgia is an in-depth history of life events to discover specific mechanisms of injury accompanied by close view & sensitive palpation of structures of the naked body as the various body parts function in real time.
Static 2-dimensional imaging studies, whether X-ray, CT, or MRI, are relatively valueless compared to the data able to be gathered by the seasoned wise minds of inquisitive clinicians who have had extensive self-training in physical examination of living human tissues.
Unfortunately, the business model of modern medicine and the standard 15 minute appointment has long rung the death knell for true medical diagnosis of disorders of the Super-Syndrome termed Fibromyalgia.
It is a firm precept of the medical arts and sciences that rational therapies and true healing require first the knowledge of the true cause of a disease or disorder. With Fibromyalgia the true causal knowledge has been sorely overlooked.
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