Chronic pelvic pain

A woman may experience pelvic pain or discomfort during intercourse, when having a bowel movement, or when sitting down. It can be cyclical and intensify near the time of menstruation.

The location of the pain can include:

• Vulvar pain, which is pain felt on the surface (outside) of the vagina at the vulva, or labia

• Vaginal pain, which is felt within the vagina

• Deep pain, which can occur in the lower back, pelvis, uterus and bladder.

Common causes of pelvic pain

Common causes of intercourse pain could be linked to:

• Poor communication between partners

• Daily stress

• Physical conditions (such as pregnancy)

• Menopause

• Medication use (birth control pills and mood stabilizers)

• Illness (vaginal infections, endometriosis or vulvadynia)

• History of sexual assault

• Tension in pelvic floor muscles

Pain that starts deep inside (near the cervix) could be a warning sign of an internal problem that might include:

• Pelvic Inflammatory Disease

• Infection

• Problems with the uterus

• Endometriosis

• Scar tissue

• Ovarian cysts

• Irritable bowel syndrome

• Interstitial cystitis

Diagnosing pelvic pain

In order to determine the appropriate treatment, it is critical to identify the underlying cause of a woman’s pelvic pain.

Your physician may recommend certain tests and examinations to diagnose the cause of pelvic pain, including:

• Pelvic examination to look for signs of infection, abnormal growths or tense pelvic floor muscles

• Cell samples, or cultures, from your cervix or vagina to check for infection, including sexually transmitted diseases

• Laparoscopy to look for abnormal tissues or signs of infection in your pelvis, particularly if endometriosis is suspected or to look for signs of chronic pelvic inflammatory disease

• Ultrasound, abdominal x-rays or other imaging studies to help detect abnormal structures or growths in the pelvis and uterine cavity

Treatments for pelvic pain

UW Health obstetricians and gynecologists are experienced in diagnosing and treating pelvic-pain disorders.

Once the underlying cause of the pain has been identified, there are several possible treatment options, including:

• Pain relievers, including over-the-counter or prescription depending on the intensity of the pain

• Hormone treatments, such as birth control pills or other hormonal medications

• Antibiotics if the pain is the result of an infection

• Antidepressants

• Physical therapy

• Counseling

• Mindfulness-based stress reduction or other stress management techniques

• Trigger point injections

• Nerve separation (ablation)

• Surgery

You might need to try different combinations of treatment options to find a satisfactory level of pain relief.