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Is CBD Helpful in Preventing Pelvic Pain?

I suffer from pelvic pain, specifically vaginismus, and wonder if the benefits of CBD for pain would apply to me? Are CBD salves or lubricants safe to use internally? Will CBD actually reduce the pain one experiences with vaginismus?

Discussion

Vaginismus is a medical condition where the muscles of the pelvic floor (the muscles that support the bladder, vagina and rectum) have excessive tension. This can lead to both pelvic pain and pain with sex. There is no data to support using CBD vaginally (or by any other route) for this pain condition. There is some evidence linking cannabis use in the previous four months with increased vaginal yeast colonization, but CBD has not been studied independently.

CBD, or cannabidiol, is a nonpsychoactive compound found in cannabis. CBD is increasingly being found to be helpful for many medical conditions, not just ones that are painful. The data supporting CBD use is for specific conditions, so it is important to look at the facts so you can make an informed choice about your body.

CBD may play a role in reducing pain and muscle spasm for some conditions, but there are still lots of unknowns. An oral spray with THC (tetrahydrocannabinol, which is the main psychoactive component of cannabis) and CBD is approved for use in other countries for muscle spasm caused by multiple sclerosis as well as for some kinds of chronic pain. However, it is not possible to directly translate this data to vaginal use or to apply it to a different medical condition.

Research is not yet available to reveal how CBD would act vaginally since cannabinoid receptors in the vagina have not yet been studied. We also don’t know how much CBD would be absorbed into the bloodstream or if absorption is needed to produce an effect. (In this case, if the drug has to enter the bloodstream to work, there is probably no benefit to vaginal use).

Also, it is not known what effect CBD could have on the pelvic floor muscles. There is one study that finds natural endocannabinoids actually reduce during sexual excitement, so it is biologically plausible that CBD could increase pelvic floor muscle tone (meaning it would be very unhelpful for spasm). There is also some data that suggests cannabis use is associated with a higher rate of vaginal yeast colonization. It is not yet known if this is from the THC, CBD or other cannabinoids.

Consult a Medical Professional

When experiencing pelvic floor pain, an evaluation with a specialist, such as a urologist or gynecologist, is recommended. Pelvic floor physical therapy may be included in a treatment plan for pelvic pain. Cannabis can help reduce pelvic pain symptoms and discussion with a medical provider may be beneficial as part of a treatment plan.

Studies have reported that many patients with urologic chronic pelvic pain syndrome (UCPPS) have tried the use of marijuana or cannabis for treatment due to its reputation of providing benefit to patients with chronic pain when traditional treatments do not produce desired outcomes.

Possible modes by which marijuana has shown the potential for benefit in basic science research include theoretical analgesic, antiemetic, antispasmodic, anti-inflammatory, antibacterial, relaxant, and anxiolytic properties.  Some studied benefits of marijuana or cannabis include:  THC (the psychoactive cannabinoid) for the stimulation of appetite, reduction of post-traumatic stress disease (PTSD) symptoms, and as a sleep aid. CBD (the non-psychoactive cannabinoid) reduces inflammation, relieves anxiety, and reduces seizures. The combination of CBD and THC may act as a muscle relaxant, relieve spasms, reduce nausea, and relieve pain.

Research from a number of studies have noted that while cannabis therapy may not be ideal for pain relief, cannabis may help people cope with chronic pain. Although there is limited data regarding clinical research to support the use of cannabis in the treatment of UCPPS, there is evidence to support the potential benefits of medical marijuana in spastic disorders, PTSD, irritable bowel syndrome, rheumatic diseases, anxiety, depression, sleep disorders, inflammation, and chronic pain. Currently there is no solid, long-term data for UCPPS management, with further studies necessary to define the potential role of marijuana and cannabis in treatment.

For patients who are having trouble coping because of pain that has not responded to the standard therapies outlined in this supplement, turning to opioids as the last resort is not usually the best approach. Opioids, at best, offer around a 30% improvement in pain and at worse, offer a paradoxical slow exacerbation in pain intensity. With even minor pain relief comes the possibility of physical or at least psychological dependence to opioids, with desire for further increasing doses with diminished returns. Marijuana has fewer downsides, with the possibility of similar pain relief, better psychological coping, and less chance for addiction and dose escalation.

Conclusion

Bottom line, as of this writing in 2019, much remains inconclusive about CBD and the vagina. For now, it is recommended that any woman (or man) with pelvic floor muscle spasm see a gynecologist or urologist, as well as a specialized pelvic floor physical therapist, as they possess medical expertise in that area.

Read Dr. Jen Gunter article in The New York Times
Read J. Curtis Nickel, MD, FRCSC about medical marijuana for urologic chronic pelvic pain
Read more here about using cannabis to treat persistent pelvis pain

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