Pelvic Pain

Chronic pelvic pain has many possible causes, and the symptoms may vary with what's causing the pain.

Gynecologic Causes

Endometriosis

Endometriosis is a condition in which the lining of the uterus (endometrium) grows outside the uterus. The lining can attach to the ovaries, fallopian tubes, intestines or other structures in the pelvis. Adenomyosis occurs when tissue from the lining of the uterus grows in the muscle of the uterus.

Endometriosis may cause pelvic pain, especially during menstruation. Hormones of the menstrual cycle cause the endometriosis to bleed each month. This can be painful and result in the formation of pelvic adhesions, also known as scar tissue. Blood trapped in the ovary can build up into a cyst. This is called an endometrioma.

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The diagnosis of chronic pelvic pain requires a good patient history and physical exam. At your appointment, please come prepared to discuss many aspects of your health, including your past medical history, pain history, sexual history and mental health.

The physical exam will thoroughly assess the many possible sources of pelvic pain discussed under "Symptoms," with particular attention to the musculoskeletal system including the back, abdomen and pelvis. A Q-tip test may be performed to test the nerves outside and near the vagina.

If needed, we may order other diagnostic tests such as blood work, urine tests, a pelvic ultrasound or laproscopy. You may be referred to a urogynecologist if you have bladder symptoms, or a gastroenterologist if you have gastrointestinal symptoms. If you have a musculoskeletal component to your chronic pelvic pain, we may refer you to a physical therapist for further evaluation and treatment.

Treatment for chronic pelvic pain is tailored to each patient, depending on the underlying causes of the pain. Some treatment options include:

• Hormones for conditions such as endometriosis or heavy menstrual bleeding.
• Pain medications such as narcotics, nonsteroidal anti-inflammatories or medicines for nerve pain.
• Surgery for some women with adhesions, adenomyosis or endometriosis.
• Physical therapy and biofeedback for women with myofascial (connective tissue) or muscle pain.
• Psychological therapy, medication, or both to help you cope with chronic pain. A therapist can offer support and tools to handle living with chronic pain, and can also help you and your partner cope with the relationship and sexual issues that can arise as a result of chronic pain.

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