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This topic focuses on pelvic pain that has lasted longer than 6 months. If you have new, sudden pelvic pain, see your doctor as soon as you can. To learn more about new pelvic pain, see the topic Abdominal Pain, Age 12 and Older.
Female pelvic pain is pain below a woman's belly button. It is considered chronic, which means long-lasting, if you have had it for at least 6 months. The type of pain varies from woman to woman. In some women, it is a mild ache that comes and goes. In others, the pain is so steady and severe that it's hard to sleep, work, or enjoy life.
If your doctor can find what's causing the pain, treating the cause may make the pain go away. If no cause is found, your doctor can help you find ways to ease the pain and get your life back.
Some common causes include:
Doctors don't really understand all the things that can cause chronic pelvic pain. So sometimes, even with a lot of testing, the cause remains a mystery. This doesn't mean that there isn't a cause or that your pain isn't real.
Sometimes, after a disease has been treated or an injury has healed, the affected nerves keep sending pain signals. This is called neuropathic pain. It may help explain why it can be so hard to find the cause of chronic pelvic pain.
The type of pain can vary widely. Chronic pelvic pain can include:
Chronic pain can lead to depression. Depression can cause you to feel sad and hopeless, eat and sleep poorly, and move slowly.
At your first visit, your doctor will do a complete pelvic examination to look for problems with your reproductive system. The doctor will also ask questions about your past and present health and about your symptoms. You may have some tests, such as:
Emotional issues can play a big role in chronic pain. Your doctor may ask questions to find out if depression or stress is adding to your problem. You may also be asked about any past or current sexual or physical abuse. It can be hard to talk about these things, but it's important to do it so you can get the right treatment.
If the first tests don't find a cause, you may have other tests that show pictures of the organs in your belly. These may include a transvaginal ultrasound and an MRI or CT scan of the pelvis. You may also have a type of minor surgery called laparoscopy (say "lap-uh-ROS-kuh-pee"). In this surgery, the doctor puts a thin, lighted tube with a tiny camera through a small cut in your belly. This lets the doctor look for problems like growths or scar tissue inside your belly.
Finding the cause of pelvic pain can be a long and frustrating process. You can help by keeping notes about the type of pain you have, when it happens, and what seems to bring it on. Show these notes to your doctor. They may give clues about what is causing the problem or the best way to treat it.
If your doctor found a problem that could be causing your pelvic pain, you will be treated for that problem. Some common treatments include:
Chronic pain can become a medical problem in itself. Whether or not a cause is found, your doctor can suggest treatments to help you manage the pain. You may get the best results from a combination of treatments such as:
You may need to try many treatments before you find the ones that help you the most. If the things you're using aren't working well, ask your doctor what else you can try. Taking an active role in your treatment may help you feel more hopeful.
Learning about chronic female pelvic pain:
If you have pelvic pain, your doctor will consider a broad range of possible causes. Female pelvic pain is typically caused by a medical condition involving the reproductive organs, muscles of the abdominal wall, urinary tract, or lower gastrointestinal tract. Some causes are always short-term (acute), and others can become long-lasting (chronic) unless successfully treated.
Female pelvic pain can be a difficult-to-solve medical mystery. Experts have yet to understand all possible causes of pelvic pain, particularly when it has become chronic. For this reason, some women have chronic female pelvic pain with no known cause, even after a lot of testing. This does not mean, though, that there isn't a cause behind the pain nor that there is no possible treatment.
Chronic pain with no diagnosable cause can occur in any part of the body. Long after a disease or injury has healed, nerves can continue firing pain signals (neuropathic pain). This is thought to be caused by an overloading of the nervous system by extreme or long-lasting pain. It also helps explain why it's fairly common for chronic pelvic pain to have no obvious cause.
Conditions that can cause acute pelvic pain include:
Conditions that can cause chronic pelvic pain include:
Female pelvic pain symptoms can include:
Symptoms that can accompany pelvic pain, depending on the cause, include:
Depression symptoms are commonly linked to chronic pain. Signs of depression include sleep problems, appetite changes, feelings of emptiness and sadness, and slowed body movements and reactions. If you have depression symptoms, see your doctor. For the best chance of recovery from pain, depression must be treated along with any known physical causes of pain.
Experts have yet to understand all possible causes of female pelvic pain, particularly when it has become chronic. For this reason, the cause of pelvic pain sometimes remains unknown, even after a lot of testing. This does not mean that there is no cause behind the pain. Fortunately, even without knowing the cause, there is available treatment for relieving the pain.
Because female pelvic pain can be caused by one or more conditions, its course can have just as many variations.
In some cases, pain that lasts 4 to 6 months can become chronic pain, which is a medical condition in itself. Even after the cause of pain has been treated, the affected nerves don't stop transmitting pain signals. This is called neuropathic pain, a type of chronic pain. When chronic pain has set in, it's possible that treatment will manage the pain yet not cure it.
About half of women with chronic pelvic pain report a history of sexual or physical abuse.1 Although it is not well understood, past or current abuse is strongly linked to chronic pelvic pain. If you have a history of abuse, counselling is recommended as part of your pain treatment plan.
Factors that increase a woman's risk of developing female pelvic pain that becomes chronic include:
If you have chronic female pelvic pain that has not yet been evaluated, call your doctor for an appointment.
If you have chronic pelvic pain that has already been evaluated, call a doctor for immediate care if sudden, severe pelvic pain occurs with or without vaginal bleeding.
Call a doctor if:
Even if you have existing pain or other symptoms, call your doctor if you notice new pelvic symptoms.
Watchful waiting is a period of time during which you and your doctor observe your pelvic pain symptoms without using additional medical treatment. During this period, you can keep a daily record of your symptoms, menstrual cycle, and any other life events that you consider important. A watchful waiting period may vary from a few days to weeks or possibly months.
Experts have noted a link between abuse and chronic pelvic pain.1 If you have ever been physically or sexually abused, the physical and psychological trauma you have suffered may be playing a part in your pain. For this reason, it's important that you have a health professional with whom you are comfortable discussing any past or current abuse, as well as your current symptoms.
If you have had long-lasting (chronic) pelvic pain that hasn't responded to treatment or seems to have no physical cause, you may have developed neuropathic pain, which means your nerves continue to fire pain signals long after an original injury or disease has healed. If your doctor suspects that you have neuropathic pain, he or she may refer you to a pain management clinic for evaluation and treatment.
To prepare for your appointment, see the topic Making the Most of Your Appointment.
There are many possible causes of female pelvic pain, so it is important to see your doctor for a thorough evaluation. Although your condition may be easily diagnosed during your first examination, expect that you might have a series of medical appointments and tests. For many women with pelvic pain, diagnosing the cause is a process of elimination that takes a while to complete.
If possible, bring with you a calendar or diary of your symptoms, menstrual cycle, sexual activity, physical exertion, and any other factors that you consider important, such as stressful events or illnesses. To begin narrowing down the list of possible causes of your pain, your doctor will review your symptom diary and:
You may also have additional tests, depending on whether you've recently had a Pap test or are sexually active. These may include:
Experts have noted a link between abuse and chronic pelvic pain.1 If you have ever been physically or sexually abused, your pelvic pain may be made worse by physical and psychological trauma. For this reason, it's important that you choose a health professional with whom you are comfortable discussing any past or current abuse as well as your current symptoms.
If your initial examination hasn't detected a cause of your pain, or if your results suggest a specific condition, your doctor will recommend further testing. Commonly used tests for further diagnosis of pelvic pain include:
Chronic pain can have a wearing effect on the mind and emotions, which can in turn make pain management more difficult. Your doctor may recommend a mental health assessment. You will be asked questions to find out whether such conditions as depression, insomnia, or stress are contributing to or being caused by your chronic pain. For the best chance of recovering from pain, these conditions must be treated along with any known physical causes of pain.
A laparoscopy or other test that reveals no apparent problems (negative test result) does not necessarily mean that no physical cause is present. Examinations and tests for causes of female pelvic pain are not yet able to detect all causes.
Treatment for chronic female pelvic pain can be approached in two ways: treating a known, specific cause of the pain or treating the pain itself as a medical condition. If possible, your doctor will combine the two approaches.
Based on your history, pelvic examination, and testing results, your doctor may find one or more conditions that could be causing your pelvic pain or making it worse, such as endometriosis, irritable bowel syndrome, or uterine fibroids. Depending on the cause, your treatment may include:
For both new (acute) and chronic pelvic pain, non-steroidal anti-inflammatory drugs (NSAIDs) are the first-choice treatment for relieving pain and inflammation. NSAIDs are also highly effective for relieving menstrual pain because they block production of prostaglandin, which is responsible for cramping pain. Your doctor may recommend an NSAID taken on a regular schedule. Different types of NSAIDs work for some people but not for others. If a non-prescription NSAID such as ibuprofen doesn't work, your doctor may recommend a different type, possibly a prescription NSAID.
For cyclic pain that seems to be caused or made worse by menstruation, stopping ovulation and controlling hormone levels is commonly recommended and sometimes effective.
For chronic pelvic pain, combining medical and psychological treatment increases your chances of treatment success. Medicines that may help manage your chronic pelvic pain include:
Counselling and mental skills training help you learn the mental and emotional tools for managing chronic pain and the stress that makes it worse. Commonly recommended approaches include:
Alternative pain treatments such as acupuncture, transcutaneous nerve stimulation (TENS), hypnosis, guided imagery, aromatherapy, meditation, and yoga are low-risk pain treatments that many people use to manage pain. Acupuncture and TENS have shown some success in relieving painful menstrual periods. Acupuncture has also been used as a treatment for non-menstrual chronic pelvic pain but has not been well studied.1
Surgical treatment for chronic pelvic pain should be limited to the treatment of surgically correctable problems. Surgery is most useful for treatment of a specific cause of pelvic pain, such as fibroids or endometriosis.
Surgical removal of the reproductive organs may relieve chronic pelvic pain when the cause of pain cannot be found.1 When surgery is done for pain with no known cause (hysterectomy or cutting of specific pelvic-area nerves), there is a risk of persistent or worsened pain after surgery as well as surgery-related side effects.
After 4 to 6 months of pain, some people develop chronic pain, which is a medical disorder that is separate from the original pain-causing condition. Because chronic pain and female pelvic pain have yet to be fully understood, treatment can be a trial-and-error process. It is common for women with chronic female pelvic pain to try many treatments before finding one or more that are helpful.
Decisions are complicated when considering treatment for chronic pelvic pain. Evaluate the following:
Early diagnosis and treatment of pelvic pain may help prevent chronic female pelvic pain.
One cause of chronic pelvic pain is pelvic inflammatory disease (PID). You can greatly reduce your risk of PID by protecting yourself from sexually transmitted infections (STIs).
Preventing an STI is easier than treating an infection after it occurs.
Condom use reduces the risk of becoming infected with an STI, especially gonorrhea, chlamydia, and HIV. Condoms must be in place before beginning any sexual contact. Use condoms with a new partner every time you have sex, until you know from test results that he or she does not have an STI.
Abstaining from sexual contact is the only certain way to avoid exposure to STIs.
Home treatment may help ease female pelvic pain and can be used along with your medical treatment plan.
To relieve your pain:
Treatment with medicine does not cure female pelvic pain. But controlling pain can help prevent it from getting worse or becoming chronic.
The following may help relieve symptoms:
No single medicine successfully treats chronic pelvic pain in all women.
Treating chronic pelvic pain with medicine is usually preferable to using a surgical option. Surgery is only recommended when a correctable cause of pain is clearly known. Even in these cases, there are no guarantees that surgery will relieve pain or that it will not cause further problems.
Chronic pelvic pain symptoms sometimes stop naturally when menopause occurs. If you are close to menopausal age (usually around age 50) and your symptoms are likely related to hormones, your best option may be home treatment and medicine until menopause occurs.
Surgical removal of the reproductive organs may relieve chronic pelvic pain when the cause of pain cannot be found.1 When surgery, such as hysterectomy or cutting of specific pelvic-area nerves, is done for pain with no known cause, there is a risk of persistent pain or pain that is worse after surgery as well as surgery-related side effects.
Laparoscopy to diagnose chronic pelvic pain may be done before treatment with medicines (other than birth control pills) or surgery. Sites of endometriosis (implants) or scar tissue (adhesions) may be removed or destroyed during the laparoscopy.
Hysterectomy is only a good treatment choice for chronic pelvic pain when a documented disease or surgically correctable condition of the pelvic organs is present. When hysterectomy is done solely for relief of pelvic pain, the results may be disappointing.
Surgery may lead to complications that cause added pain, discomfort, or other problems such as infection or scar tissue.
Symptoms caused by chronic pelvic pain often go away without treatment when menopause occurs and hormone fluctuations settle down. Controlling symptoms with home treatment or medicines until menopause may be an option. Symptoms of chronic pelvic pain may return if you decide to use hormone replacement therapy for perimenopausal symptoms. If you are nearing menopause, talk with your doctor about your options.
Female pelvic pain treatment can be enhanced with counselling, mental skills training, relaxation, and physiotherapy treatment.
Counselling and mental skills training help you learn the mental and emotional tools for managing chronic pain and the stress that makes it worse. Commonly recommended approaches include:
Physiotherapy can help you learn specific exercises to stretch and strengthen certain muscle groups. Physiotherapy helps you to improve posture, gait, and muscle tone.
Alternative pain treatments for chronic female pelvic pain are not well studied but are considered helpful for managing stress and building mental mastery over pain. Acupuncture and transcutaneous nerve stimulation (TENS) have shown some success in relieving painful menstrual periods. Acupuncture has also been used as a treatment for non-menstrual chronic pelvic pain but is not yet well studied.1
Other low-risk alternative pain treatments that many people use to help manage pain include:
Chronic pelvic pain takes time to develop and can take a long time to treat. Take charge of how you cope with pain by using one or more of the treatment choices above. Combine your treatment with the practices you prefer for keeping a positive state of mind. For more information, see the topic Stress Management.
|Society of Obstetricians and Gynaecologists of Canada (SOGC)|
|780 Echo Drive|
|Ottawa, ON K1S 5R7|
The mission of SOGC is to promote optimal women's health through leadership, collaboration, education, research, and advocacy in the practice of obstetrics and gynaecology.
|Canadian Women's Health Network|
|419 Graham Avenue|
|Winnipeg, MB R3C 0M3|
The Canadian Women's Health Network (CWHN) is a network of individuals, groups, organizations, and institutions. CWHN promotes information sharing, education, and advocacy for women's health and equality, and provides resources and information on women's health issues. In addition, it runs a clearinghouse of women-centred, health-related resources. The Web site also includes new research articles, information sheets, and press releases.
|International Pelvic Pain Society|
|1111 North Plaza Drive|
|Schaumburg, IL 60173-4950|
Chronic pelvic pain affects millions of women. However, new surgical and medical therapies are available that may offer hope for women suffering from chronic pelvic pain. The International Pelvic Pain Society brings physicians, psychologists, physical therapists, and basic scientists together to coordinate, collect, and apply this growing body of information, and the organization serves as a forum for professional and public education.
- American College of Obstetricians and Gynecologists (2004, reaffirmed 2008). Chronic pelvic pain. ACOG Practice Bulletin No. 51. Obstetrics and Gynecology, 103(3): 589–605.
- Fall M, et al. (2010). EAU guidelines on chronic pelvic pain. European Urology, 57(1): 35–48.
Other Works Consulted
- Jarrell JF, et al. (2005). Consensus guidelines for the management of chronic pelvic pain. SOGC Clinical Practice Guideline No. 164, Part 1. Journal of Obstetrics and Gynaecology Canada, 27(8): 781–801. Available online: http://www.sogc.org/guidelines/public/164E-CPG1-August2005.pdf.
|Primary Medical Reviewer||Sarah Marshall, MD - Family Medicine|
|Primary Medical Reviewer||Andrew Swan, MD, CCFP, FCFP - Family Medicine|
|Specialist Medical Reviewer||Kirtly Jones, MD - Obstetrics and Gynecology|
|Last Revised||March 21, 2011|
Last Revised: March 21, 2011
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