For years, I have seen patients come to Clear Passage Therapies (CPT) with secondary infertility and find success. I’ve spoken with many of these women and written their personal experiences with infertility for the upcoming book, Miracle Moms, Better Sex, Less Pain. I have also had the opportunity to write or edit 78 other stories for the book that discuss various forms of infertility, sexual dysfunction, and chronic pain. I’ve also followed-up with many more patients who came through CPT’s doors.

Through these experiences, I’ve come to recognize subtle nuances between the different groups of women who come to CPT. In women with secondary infertility, I’ve recognized their distinct frustration and confusion. Many of them ask, “Why was it so easy to become pregnant before, but now now?” I’ve also noticed a twinge of guilt in this group of women: a sense that because they already have a child, they should be more grateful and not “complaining” about the difficulty of conceiving a second child.

I find it incredibly sad to hear women question their desires to expand their families due to conflicting feelings of guilt and frustration. I largely feel this way because I feel they have a high chance of discovering the cause of their infertility and resolving it.

A woman who had no problems conceiving her first child has, in a way, a “leg up” on other women because her doctors can look and see what has changed since that pregnancy. If a doctor performs routine tests and cannot find a cause, a woman is still not out of options. At CPT, we believe that many causes of unexplained infertility are mechanical in nature and thus due to adhesions. Adhesions may form after any type of injury or trauma to the body. They can constrict, cover, and pull on important tissues and organs, leading to infertility. The birthing process itself can cause trauma to the body and subsequent adhesion formation. Our therapists have also seen a correlation between secondary infertility and previous c-sections or episiotomies. When examining a patient, our therapists also review a patient’s history for any trauma that has occurred since childbirth – perhaps a severe fall, car accident, yeast or bladder infection, or surgery. These events signal adhesion formation.

CPT has had success treating unexplained infertility and secondary infertility by addressing adhesions that form in the body. However, we have never advertised this fact on our website until recently. After speaking with so many women who had success after being treated for secondary infertility at CPT, I worked with the CPT team to design a web page specifically about how we treat this condition. The page was loaded in late February and I happy that women who suffer from secondary infertility can learn about a new treatment choice. I encourage you to review the site and let us know what you think below. If you feel there’s something else we should address on this page, just leave a comment below. To read more about secondary infertility, see 10 Clues to Solving Secondary Infertility,

An episiotomy is a surgical incision of the perineum (the area between the vagina and the anus) that is made while a woman is giving birth in order to enlarge the vaginal opening for delivery. Following the birth, the doctor then sutures the area closed. After a few weeks, most women no longer experience pain around their stitches, though doctors generally recommend that a woman wait six weeks to have sex again.

When women continue to experience pain near the episiotomy site after six weeks has passed, it is a sign that adhesions may have formed. When any part of the body is injured, collagen rushes to the area to contain incoming bacteria, prevent the loss of blood, and enable the area to be healed. However, this sticky collagen builds to form adhesions that can also adhere to neighboring structures or constrict the tissues it covers.

Women who have episiotomies experience trauma to the peritoneum, pelvic floor muscle, and vagina. If the pelvic floor muscle has adhesions, a woman may experience pelvic pain, painful intercourse, urinary incontinence, and infertility (see Secondary Infertility). The peritoneum and vagina are very pain-sensitive structures and minimal adhesion formation can cause great pain, especially during intercourse or urination.

The “hands-on” work practiced at Clear Passage Therapies® clinics (see What is the Wurn Technique?) is designed to reduce or eliminate adhesions, crosslink by crosslink. After treatment, many women find that the constant pulling or tightness sensation is gone, intercourse pain is eliminated, and sexual function is increased (for more info, read The G-Spot and Sexual Dysfunction).

One aspect I personally love about working with Clear Passage Therapies (CPT) is their continued work and effort towards research and education. The entire CPT team loves to conduct studies, closely follow the progress of patients, and look for ways to improve treatment. Once the CPT team feels that treatment can help or improve a certain condition, we share this news on our website.

Today, a new page was added to our website: C-Section Pain. CPT first began treating c-section pain when women came to the clinic for treatment of secondary infertility (unable to become pregnant after previously conceiving and carrying a child). A large majority of the women had also undergone c-sections and experienced pain at or near their incision sites. Some reported a constant pull near their scar, while others reported persistent pain that started after their c-section and gradually increased.

Our therapists felt that the c-section pain or discomfort these women experienced was tied to their infertility. At CPT, we believe the body functions as a whole; pain and dysfunction in one area is often linked to pain or dysfunction in another area. When our therapists examined the patient’s body, they could feel adhesive patterns near the incision sites, extending down into the uterus. They felt that these adhesions not only caused the woman’s pain, but significantly impaired her fertility. As our therapists worked to reduce the adhesions, the patient reported she no longer experienced pain near their c-section. A few months after treatment, she also became naturally pregnant!

The CPT team began to notice that many women with prior c-sections were reporting decreased pain and improved digestion after treatment for secondary infertility. We continued to follow our patients closely and researched more about how our patients with c-sections could benefit from treatment.  After significant time and work, our therapists can now confidently say they can treat pain and dysfunction associated with c-sections. To celebrate and share the news, the CPT team created a new web page for C-section pain. The CPT team will continue to unveil new web pages over the next month, so keep checking back to see the numerous ways we are researching and developing the field of manual physical therapy.

Most women who experience secondary infertility would never consider the possibility that a sexually transmitted disease (STD) was the culprit. For many women, the suggestion is offensive because they have remained happily wed through their first pregnancy and while trying to conceive a second time. Other women who are with different partners are still reluctant to consider an STD because of the stigma associated with it.

But a new study released by Fertility and Sterility (Jan 2009) shows that women who experience secondary infertility cannot readily rule-out the possibility of an STD.  The study examined women who experienced secondary infertility and found that 55% of the participants tested positive for Chlamydia. Chlamydia is a particularly difficult STD to catch because it causes no visible or sensible side-effects. It can silently ravage a woman’s fertility by causing chronic inflammation and adhesions to form.

70% of the women who tested positive for the infection had an inactive infection – meaning it could have been present before the woman’s first pregnancy and went undetected. An inactive infection does not mean that a woman’s fertility is safe. The study found that Chlamydia (whether active or inactive) was the cause of secondary infertility in 72.7% of the women. Chlamydia caused total tubal occlusion (both fallopian tubes blocked) in 63.6% of the women with the infection (both active and inactive).

The study concluded that screening for Chlamydia is strongly recommended for women experiencing secondary infertility. Although social taboos around STD may make you feel embarrassed about being tested, it is well worth looking past this to find the cause and proper treatment of female infertility.

When a woman comes to CPT with secondary infertility, one of the first questions our therapists ask is, “Did you have a C-section?”

Through years of experience, our therapists have found that c-sections frequently cause adhesion formation within the abdominal and pelvic cavity. Adhesions can impede fertility by blocking the fallopian tubes, restricting the uterus, pulling on the ligaments attached to the uterus, and many other ways.

Scientific studies have demonstrated the direct link between c-sections and adhesion formation time and time again. A new study released by Fertility and Sterility (Dec 2008) went a step further and found that the appearance of a c-section scar can predict the severity of adhesion formation within the abdomen.

The study examined 101 women who had previously undergone a c-section. The scientists first examined the c-section scar and noted pertinent characteristics, such as if the scar was flat or depressed (going into the skin). The scientists then examined intra-abdominal adhesions when the women had a second c-section (all women who enrolled in the study planned to have a second c-section).

The study found that 43% of the women had adhesions (either filmy or dense). Of these women, the only significant indicator of adhesions was a depressed scar.

If you are currently struggling with secondary infertility after a c-section, you may find it beneficial to examine your scar to see if it is indented into your abdomen. If it is, you may want to learn more about how adhesions can impact your fertility, or read our article, “How Adhesions Form and Impair Fertility.”

If your scar is not depressed, you are still not out of the clear. Adhesions can form after a c-section and not cause an indented scar.  To learn more about common signs of adhesion formation, please visit our adhesion and fertility page.

Women who experience secondary infertility are often baffled by their diagnosis. “I was able to easily conceive before,” many women tell us. “Why am I now having trouble?”

When our therapists examine women with secondary infertility, they look for ten key changes:

1. C-Section – Did the patient have a c-section? Adhesions and scar tissue after a c-section can cause blocked fallopian tubes or prevent proper implantation
2. Episiotomy – Did the patient have an episiotomy? An episiotomy scar can cause adhesions that extend into the vagina and cervix, causing the cervix to become stiffened and prevent the passage of sperm
3. Hormonal Changes – Has the patient had her hormone levels checked since giving birth? Has the patient’s period changed in heaviness or number of days? Pregnancy and aging can cause hormones to change, which may be causing infertility
4. Surgeries – Did the patient undergo any surgeries since pregnancy? Surgeries can cause adhesions to form and impair fertility
5. Trauma – Has the patient experienced any car accidents, falls, abuse, or similar traumatic events? These events can cause long-lasting injuries, pelvic imbalances, adhesion formation, and other factors that can negatively impact fertility
6. Infection – Has the patient had any bladder, vaginal, or yeast infections since pregnancy? Infections can cause adhesions to form in the delicate structures of the female pelvis. These adhesions can impair female fertility in multiple ways
7. Inflammation – Has the patient been diagnosed with any new inflammatory conditions, such as endometriosis or PID? Inflammation directly causes adhesion formation, which can lead to infertility
8. Pelvic or Back Pain – Has the patient experienced any hip, back, or pelvic pain since pregnancy? Pain is a sign that something is wrong. Pain in the pelvis may be linked to infertility, such as a hip injury that is located near the fallopian tubes.
9. Sexual Dysfunction or Intercourse Pain – Has the patient experienced any sexual dysfunction or intercourse pain since pregnancy? Any problems in decreased desire, arousal, lubrication, orgasm, or satisfaction is a sign that adhesions have formed in the delicate structures of the reproductive tract, possibly causing infertility
10. Ovulation or Menstrual Pain – Has the patient experienced any new ovulation or menstrual pain since pregnancy? Ovulation pain is a sign that adhesions may be restricting and impairing the proper function of the ovary. New menstrual pain is a sign that adhesions may have formed around the uterus, preventing proper implantation.

For more information about treating secondary infertility, please visit our adhesions and infertility page.