London UK Pelvic Specialist manual therapy for Vaginismus, Clitoral pain, Pudendal neuralgia, Coccyx - Tailbone pain, Persistent genital arousal disorder (PGAD), Vestibulodynia, Vulvodynia, Women's Pelvic health and Men's Pelvic health.

Our specialist pelvic manual treatment team at Sayer Clinics: London UK is world-leading for efficient diagnosis and effective treatment for vaginismus & complex pelvic and coccyx pain.

Sayer Clinics efficiently diagnoses and effectively treats pelvic and coccyx pain, pregnancy symphysis pubis dysfunction (SPD) pelvic girdle pain, pelvic floor pain and dysfunction, pudendal neuralgia PN and pudendal nerve entrapment PNE.

Sayer Clinic Kensington, West London, W8 6PX

Sayer Clnics has vast clinical experience in spinal and pelvic manipulation using spinal, sacroiliac and sacro-coccygeal radiology or diagnostic ultrasound.

The Sayer Coccyx and Pelvic team is able to successfully treat Symphysis pubis Dysfunction (SPD), Sacroiliac and Coccyx pelvic joints, external and internal muscles, ligaments, fascia and nerve pathways using joint manipulation and myofascial mobilisation.

Our practitioner's continuing professional development focus has been on the pelvis and coccyx and we have become world-leading listed practitioners with www.coccyx.org and the International Pelvic Pain Society (IPPS) since 2006.

Our founder and mentor is an International and UK leading specialist in Symphysis Pubis Diastasis (SPD) pubic joint pain and associated pelvic floor pain and sacroiliac pelvic pain before, during and after pregnancy with extensive specialist postgraduate training with the leading USA pelvic pain physical therapy experts, Dr Amy Stein (author of 'Heal Pelvic Pain'), Dr Rhonda Kotarinos and Dr Stephanie Prendergast. Michael also learned with esteemed French gynaecologist Dr Eric Bautrant at courses and international Coccyx and Pelviperineal conferences where they have both presented.

He has shared his expertise with our exceptional colleague, Specialist Physical Therapist Maria-Madalina Grigore, who practices at Sayer Clinic: Kensington and is now the only Practitioner in the UK, who has learnt all my calls, uniquely effective techniques to resolve chronic (long-term) and acute (short-term) musculoskeletal pudendal, pelvic and coccyx pain.

He lectured at University College London (UCL) on MSc Masters courses and to AECC University College students as well as doctors, therapists, specialists and professors at conferences and symposia in many countries focussed on musculoskeletal and pelvic nerve-related pelvic and coccyx pain providing efficient diagnosis, effective hands-on manual treatment with intelligent exercise and lifestyle changes without resort to steroid injections, invasive surgery or dependence on opioid prescription drugs.

He presented 10 hours of unique specialist expertise on pelvic and coccyx pain at the 8th World Congress of Low Back and Pelvic Pain in Dubai in 2013, and then at the 1st Coccyx Symposium in Paris in July 2016, 2nd Coccyx and Pelvic Pain Symposium in Dordrecht, Holland in July 2018 and at the 3rd international Coccyx Symposium held in Munich in June 2021 and is invited by Dr Jean-Yves Maigne to give a presention on 'Effects of Posture on Pelvic and coccyx pain' at the 4th Symposium in Paris in June 2023 with focus on the close link between Coccyx pain and Pelvic Floor / Pudendal Neuralgia at the Convergences Pelvic Pain conference at Madrid Medical School in November 2019 which involved extensive human dissection of pelvic nerves pathways.

Michael has also, for over a decade, conducted ground-breaking research into effective pelvic and coccyx pain manual treatment as well as post-partum coccyx pain (coccyx pain after childbirth).

He has advised major London teaching hospitals on the mechanism of multiple cases of coccyx dislocation and distal sacral fractures following hospital deliveries particularly when Ventouse (a cup-shaped suction device) and forceps were used and which he successfully diagnosed and treated.

This wealth of academic and practical experience has made Michael Durtnall the acknowledged international leader in manipulation treatment for mechanical, musculoskeletal, asymmetrically and posturally-induced chronic pelvic pain (CPP) and tailbone pain / coccyx pain.

We have successfully treated countless patients from UK, United States, Canada, Australia, all the countries of Europe, the Middle East and around the globe who had suffered coccyx dysfunction, pudendal nerve compression and entrapment, pudendal neuralgia and pelvic pain. 

Read more than 230 patient coccyx.org testimonials for Sayer team here: https://www.coccyx.org/personal/index.htm 

Read 40+ pudendal neuralgia patient success stories on http://www.pudendalhope.info/forum/viewforum.php?f=27&sid=ce49e35b78cf11f92f5790bcd2f17efe

Sayer Clinics Pelvic Pain Physiotherapy.

Sayer Clinics specialist physiotherapy team are London’s leading pelvic pain specialists with expertise in trigger point* and myofascial release** for coccyx pain, pudendal neuralgia and pelvic floor rehabilitation.

Sayer Clinics specialist pelvic pain physiotherapists evaluate and treat pelvic pain and pelvic floor dysfunction with ongoing written and constant verbal consent and active participation of patients throughout the treatment and healing process.

We are trained to efficiently diagnose, successfully treat and give intelligence advice to all ages and are specialised in rehabilitation treatment for pelvic floor pain, abdominal muscle diastasis (muscle separation), urinary urgency, urinary frequency, urinary incontinence, pre-natal and post-partum pregnancy pain, pelvic girdle pain, PSD, pubic symphysis diastasis, pain or dysfunction, pelvic organ prolapse, dyspareunia, vestibulodynia, clitorodynia, PGAD (persistent genital arousal disorder), vaginismus, sexual pain and dysfunction. 

Treatments are conducted in private treatment rooms with focused hands-on specialist manual pelvic techniques that NHS and most private physiotherapists are not taught, even at post-graduate level. Our team are not only excellent specialist pelvic therapists but also the most caring, experienced and effective in manual and bio-psycho-social treatment of pelvic pain.

* A trigger point is a small knot in your muscle that can cause pain where it originates or further away in another part of the body. 

** Myofascial release is an effective manual technique that involves applying gentle, sustained pressure into the myofascial connective tissue to reduce pain and restore motion.

About pelvic and coccyx pain

The pelvis is effectively a basin, served by nerves and blood vessels and moved by muscles with complex stresses shared between joints and ligaments.

Within the pelvic region is the coccyx or tailbone at the bottom of the spine of three to five, often mobile, coccygeal vertebrae or spinal bones. The coccyx is connected to the sacrum by a synovial joint and is an attachment site for tendons, ligaments, gluteal and levator ani pelvic floor muscles. It is also connected to many of the muscles of the pelvic floor where its function is to flexibly support and protect pelvic organ function and help stability in the sitting position. 

This complex neuromusculoskeletal region of the body is a hugely neglected area of clinical research, yet more of us are suffering pelvic and coccyx pain and dysfunction due to our increasingly sedentary and stressful 21st century lifestyles. 

Coccyx pain – also known as tailbone pain, coccydynia or coccygodynia

Coccydynia is the most common type of pelvic floor pain. It often occurs when you misalign, injure or strain your coccyx or the surrounding muscles and ligaments. The result is pain and discomfort felt at the base of your spine that is worse when sitting and often aggravated on standing up from sitting if the top Sacrococcygeal joint is straightened like a spike or dislocated backwards. 

In some cases, the pain disappears within a few days but it can last for months and years and become permanent, severely impacting your ability to sit, drive, travel and perform daily activities.

Low back pain and sacroiliac pain is common in patients with pelvic and coccyx pain as they typically sit or lie awkwardly and twisted sideways on one or other buttock to avoid their pain in the pelvic floor or coccyx. This creates months of torsion and imbalance with asymmetrical pressure and tension in the pelvic muscles and the lumbar spine which often leads to disc degeneration, sacroiliac pain, facet joint pain, compensatory spinal curvature and painful, poor posture.

Pudendal neuralgia (PN)

Pudendal neuralgia is a long-term chronic pelvic pain where the pudendal nerves become stretched, compressed, damaged or irritated. 

The pudendal nerves are the main nerves of pelvic floor control and function, conducting autonomic as well as motor control of the pelvic floor and sexual function and transmitting sensation from urogenital system with bladder, clitoral pain, vaginal pain, labial pain, pelvic floor pain, perineal pain, ischial sitting-bone burning pain and coccyx and anal pain with sitting.

Pudendal nerve entrapment (PNE)

We are expert at manually treating Pudendal nerve entrapment which causes chronic pelvic pain when pudendal nerves are compressed by over-tight, torsioned or asymmetrically contracted pelvic obturator internus pelvic muscles or entrapped Pudendal nerves between the sacrotuberous and sacrospinatus ligaments inside the pelvis at Alcock’s canal. 

Image used with permission from Pelvic Guru®, LLC
www.pelvicglobal.com

Cluneal nerve entrapment

Sayer Clinics are the world's best specialists for manually treating Cluneal Neuralgia.

The cluneal nerves are nerves of the buttocks. Entrapment or compression of these nerves can cause a miserable and intense burning sensation in the upper (superior cluneal nerve compression) or lower buttock and pelvic floor (inferior cluneal nerve compression) with sitting. 

To read more about nerve entrapment conditions, scroll to the further reading section at the bottom of the page.

Pregnancy related pelvic girdle pain (PGP)

Pelvic girdle pain (PGP) or symphysis pubis dysfunction (SPD) is usually caused by a locking or subluxation of your sacroiliac joints or by torsional joint dysfunction with uneven mobility at both sacroiliac joints posteriorally with resulting pubic symphysis joint strain at the front of your pelvis.

Pelvic girdle pain usually occurs with gradually worsening pelvic-postural changes in the later stages of pregnancy as the symphysis relaxes and widens under the influence of pregnancy hormones as well as for many months post-partum which can cause severe pubic and clitoris, groin, hips, inner thighs and buttock pain.

Sayer Clinics are renowned as the leading UK specialist for effective pelvic joint manipulation treatment with excellent long-term outcomes in pelvic girdle pain.

Image used with permission from Pelvic Guru®, LLC
www.pelvicglobal.com

What causes pelvic and coccyx pain?

If you’re experiencing pelvic or coccyx pain, the first step is to visit your GP to rule out serious conditions such as an infection or – in rare cases – cancer. 

Most often, this type of pain is neuromusculoskeletal, which means that it can be effectively treated and physically resolved using our exemplary hands-on expertise, without the ineffective and temporary cover-up of drugs or injections.

Pelvic pain and coccyx pain may be chronic or acute and there are several possible causes:

Fracture of the sacrum or coccyx: This usually occurs following trauma, such as a fall or childbirth. Fractures from childbirth happen more frequently following intervention using a ventouse (cup-shaped suction device) or forceps with poor technique and excess force. We can visualise sacral and coccygeal fractures, even hairline coccyx fractures on our super-advanced, high-definition, low dosage x-ray system. 

Poor posture: This can be caused by obesity, weak abdominals, having a sedentary occupation, sitting slumped on sofas and poor quality office and home-work seating, postural adaptation in pregnancy and after Caesarean section (C-section).

Surgical procedures during childbirth: Having a C-section or episiotomy (surgical cut at the back of the vagina) causes scar tissue which may result in nerve entrapment, leading to pelvic pain. Ouf skilled Manual therapy resolves painful scar tissue and the sooner treatment is started the more effective the result.

Spondylolisthesis: This happens when a vertebra, usually at the base of the spine, slips forwards over the vertebra below. It is essential to mobilise and optimise the movement of the sacroiliac joints, reduce swayback, improve core and lower abdominal muscle tone and permanently improve whole-body posture to reduce and minimise long-term lower lumbar joint and disc degeneration.

Muscular strains and injuries: Strains or injuries of the gluteal muscles, or glutes (the muscles in your buttocks) may entrap the pudendal nerve or sciatic nerve. Similarly, spasm of the coccygeus muscle (a muscle of the pelvic floor) can compress the rectal branch of the pudendal nerve causing fleeting, agonising and occasionally long-term rectal or pelvic floor spasm and pain (proctalgia fugax). Chronic pelvic muscle spasm or levator ani muscle tightness is often implicated in vaginismus, PGAD, vulvar pain, reduced clitoral sensation and lack of orgasm.

Mechanical low back pain: This may result from postural sway-back, lumbar facet or sacro-iliac joint pain and dysfunction, lumbar-disc-referred sciatic leg pain, arthrosis, significant leg-length difference (over 10 mm), muscle spasm or joint locking.

What are the symptoms of pelvic and coccyx pain?

At Sayer Clinics London, we are able to effectively treat the symptoms listed below.

Patients typically experience two or more of these symptoms: 

Pain when sitting: Sitting can trigger or aggravate pelvic, pudendal and coccyx pain, particularly at work, when driving or travelling. Sometimes, this pain can be made worse by wearing tight jeans or underwear.

Pain or difficulty with bowel movements: In some cases the pain is relieved by a bowel movement, while for others the pain feels worse afterwards. The pain is felt as a result of spasms in the surrounding muscles. You may also feel the need to go to the toilet more often or experience constipation. 

Pain or difficulty with urination (dysuria): This is usually a result of spasms in the surrounding pelvic muscles. If urinary symptoms are muscular in origin, relaxing the pelvic floor, improves the flow of urine but worsened when urine is held for longer than comfortable. 

Needing to urinate more frequently: This can range from a worry to an overwhelming urge. There may be a constant subtle ache in your bladder, urethra or genitals. You may not feel 'empty’ after urination and feel a need to urinate again despite an empty bladder. You may also need to urinate often during the night – this is known as nocturia.

Thigh, calf or foot pain: Some people may feel pain or paraesthesia (a burning, prickling or itching sensation) in the pelvis. inner thighs, down the legs and to the feet referred through nerves from the pelvis or via the brain as ‘central sensitisation’. 

Groin, hip or abdominal pain: Groin pain needs to be diagnosed accurately as a hernia, muscular, bursitis or tendon-bone insertion inflammation or hip joint labral pain.

Genital pain (in males): This is felt at the tip and shaft of the penis or as testicular pain felt in one or both testicles and may be referred via pudendal nerve compression.

Genital pain (in females): Females may experience pain, paraesthesia or numbness superficially or deep inside the vagina, on one or both sides of the vulva (vulvodynia) or in the clitoris (clitorodynia) and may be referred via pudendal nerve compression most typically between the coccyx and sitting bone. 

Perineal pain: The perineum is the area between the genitals and the anus. Chronic pain in the perineum is very common in females especially after episiotomy when scar tissue is trapping nerves. In both males and females the perineum is often injured by prolonged cycling with saddle pain and compression of the pudendal nerve. This type of pain is aggravated by deep-squatting exercises, sitting or standing with increased flares of pain for hours or even the next day or after sexual activity as orgasm causes strong contractions of the pelvic muscles.

Pain during or after sex (dyspareunia): This pain may be felt on the outside as vulvar pain or as vestibular pain just inside the vagina. In some cases there will also be clitoral hypersensitivity or complete insensitivity or numbness.

Loss of interest in sex (low libido): This is common in cases of chronic pelvic pain which may be caused by low sex hormone levels, which need to be assessed.

In males low libido causes difficulty with erection resulting in anxiety and low self-esteem, reducing sexual arousal and interest. In females low libido causes difficulty with clitoral erection, arousal and inability to orgasm.

Persistent Genital Arousal Disorder (PGAD): This is a spontaneous, persistent, unwanted and uncontrollable state of genital arousal in the absence of any sexual stimulation or desire. PGAD may be linked with neurological, vascular, physiological, pharmacological and psychological factors. It may follow trauma or surgery, pudendal nerve entrapment, spinal disc bulges or compressed nerves and pelvic blood vessels.

Sayer Clinics world-leading PGAD specialist team in London, UK have a very high success rate in manually treating persistent genital arousal disorder (PGAD) at Sayer Clinic: Kensington. Maria-Madalina Grigore mobilises and frees pudendal nerve branches and deep pelvic nerves trapped or compressed within myofascial tissues often due to trauma and pelvic asymmetry. Michael mobilises sacroiliac joints and coccyx joints with deep pelvic muscle techniques to regain normal function of pelvic tissues and in many cases also diagnoses and successfully treats clitoral hood adhesions which respond extremely well to his careful clitoral hood mobilisation treatment.

CLITORAL PAIN

Clitoris pain may be sudden sharp stabbing pain or a constant raw scratchy irritation of the clitoris from touch, certain movements or the touch of underwear. 

Our patients experiencing PGAD report unwanted genital arousal with tingling, throbbing, swelling and lubrication and feeling on the verge of orgasm, without sexual desire.

In our experience at Sayer Clinic treating PGAD we find that PGAD involves overactive deep or superficial pelvic floor muscles, especially ischiocavernosus and obturator internus muscles as primary contributors to PGAD and clitoral pain via constriction of pelvic and pudendal sensory nerves with reduced blood flow through constantly hyper-contracted pelvic floor muscles.


Pelvic diagnosis and manual treatment specialist Maria-Madalina expertly examines the pelvic floor. We have found that many of our patients with chronic pelvic floor and clitoral pain have a severely contracted and immobile clitoral hood which traps hardened sebum grit or pearls under the tight clitoral hood.

We mobilise the clitoral hood and carefully remove any accumulation of hard gritty, sand-like sebum or keratin pearls. These irritant, gritty pearls are often the source of years of clitoral pain and PGAD or, conversely, eventual loss of clitoral sensitivity with inability to reach full orgasm, due to constant sharp irritation deep under the hood against an over-sensitive clitoral head. 

Our unique and long experience on neuromusculoskeletal pelvic, coccyx and clitoral pain has shown that clitorodynia commonly also occurs via superficial compression or stretch injury along the pudendal nerve pathway or locally via adhesions around the dorsal clitoral nerve branch of the pudendal nerve. In our experience it is relatively rare to diagnose pudendal nerve compression within Alcock’s canal between the sacrospinous and sacrotubrous ligaments however when this occurs we swiftly refer for expert surgical pudendal nerve release to the few excellent pudendal surgeons in UK, Europe or USA.

Pelvic asymmetry due to a shorter leg (significant leg length discrepancy of a centimetre or more) or twisted pelvic joints following birth injury trauma, falls, coccyx and sacroiliac joint dysfunction or spinal scoliosis may all be potentially involved in asymmetrically compressing pelvic nerves, muscles pudendal nerve pathways with a broad spectrum of sensory, motor and autonomic dysfunctional pelvic floor symptoms, including clitorodynia which may be itchy, burning or aching pain.

PGAD TREATMENT

Our PGAD treatment protocol depends on the specific diagnosis and origin of the clitoral pain or dysfunction. 

Effective treatment for dense sebum or smegma build-up or hard gritty, sand-like sebum or keratin pearls is to expertly, painlessly and carefully manually tease the granules from beneath the clitoral hood until the clitoris becomes clear and free from constant irritation with uninterrupted blood-flow and rapid return to mobility with a healthy pink colour. We mobilise a network of fine clitoral hood adhesions until the hood or prepuce can once again easily and freely open or retract when aroused or contract to flexibly protect and cover the clitoris to reduce touch-sensitivity from clothing throughout the day.

Maria-Madalina Grigore frees-up pudendal nerve pathways by expertly mobilising sacroiliac joints, coccyx and pelvic intramuscular pathways to normalise pudendal nerve neuromusculoskeletal function. His expert treatment often very quickly relieves the demoralising symptoms of chronic pelvic floor, anal and vaginal spasm (usually at a frequency of two contractions per second) which have in most cases persisted for many months or years).

PGAD is often associated with tailbone, anal and perineal pain or spasm, clitoris hypersensitivity or loss of sensation with inability to reach complete orgasm along with bladder symptoms such as urinary urgency, urinary frequency, incomplete voiding and nocturia. Sayer Clinics team includes specialist pelvic physical therapists and expert massage therapists.

Sayer Clinics do not advocate antidepressants, gabapentin, amitriptyline, anti-inflammatory, painkilling and numbing drugs which only partially cover-up symptoms but ensure that loss of pelvic floor function becomes chronic as the root causes are not properly addressed.

Vaginismus /  Levator Ani Syndrome / Hypertonic pelvic floor muscle dysfunction / Hyper-contracted or Shortened pelvic floor linked with Coccyx dislocation and dysfunction.

Hypertonic pelvic floor muscle dysfunction or called Levator ani syndrome or Vaginismus is a common cause of pain in the vestibule / vestibulodynia and dyspareunia / painful sex. 

Pelvic floor muscles of the posterior part of the vestibule - pubococcygeus, puborectalis and transverse perineal muscles become constantly and painfully contracted. When these muscles contract this reduces the normal blood flow through them with lower oxygenation to cells resulting in an increase in Lactic acid with a raw feeling of burning, throbbing, scratching, episodic sharp stabbing pains.

Women with levator syndrome also experience intense tenderness with reddening of the posterior vestibule where it joins the perineum and may also suffer urinary frequency, urgency and incomplete voiding as well as constipation, hemorrhoids and rectal fissures. Vaginismus is linked with low back pain and groin, hip and buttock pain often following coccyx injury years before.

Vaginismus Treatment.

Maria-Madalina Grigore is exceptional in vaginismus treatment.

Her pelvic floor dysfunction treatment involves gentle manual pelvic therapy, pelvic floor relaxation exercises, vaginal dilators and rectal or vaginal trigger point manual release therapy

Effective Vaginismus Treatment at Sayer Pelvic Pain Clinic in Kensington, London, W8

Specialist Vaginismus Treatment 

One in 500 women experience vaginismus, but likely far more as so many sufferers don’t get the right help and receive an incorrect diagnosis.

Vaginismus is involuntary, constant or intermittent super-contracted vaginal and anal levator ani musclular spasms, with moderate to severe pain making vaginal examination, tampon insertion and sex extremely uncomfortable or impossible.

Very common causes of pelvic floor muscle contraction or tightness and tension include:

1. Misaligned coccyx and sacroiliac joints, hip and spine which is often due to leg length difference of 1-2 cms creating asymmetry and tension in deep and external pelvic and spinal muscles or following previous falls and injuries to your tailbone / coccyx.

2. Straining due to chronic constipation, inflammatory pelvic or urinary tract infection (UTI) or gastrointestinal dysfunction and pain can cause permanent tension in your pelvic floor muscles. Chronic straining can also cause severe damage to the rectum with intussusception, Anismus and Rectal Dyssynergia.

Pelvic and Spinal Alignment Affects Your Pelvic Floor:

Your entire body is interconnected and misalignment affects pelvic floor muscle (PFM) dysfunction:

Dyspareunia - pain with sex

Interstitial cystitis - painful bladder syndrome

Chronic or frequent yeast infections

Chronic urinary tract infections (UTI)

Coccyx pain with sitting 

Chronic constipation

Irritable Bowel Syndrome

Stress aggravates PFM spasm

Childbirth Trauma 

Vulvodynia

Vestibulodynia

Levator ani syndrome

Other symptoms of vaginismus include:

Episodic, pelvic floor muscle (PFM) spasms lasting several hours of frequent anal, perineal and vaginal spasms at a frequency of 1-2 spasms per second.

Constipation

Difficulty Urinating

Urinary hesitation,  frequency and / or urgency

Pain with urination

Pain with pelvic exam