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.
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 makes it hard to sleep, work, or
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 back your quality of life.
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
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.
your first visit, your doctor will do a complete
pelvic exam 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
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:
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
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:
Female pelvic pain is typically caused by a medical condition involving the reproductive organs, urinary tract, lower gastrointestinal tract, or muscles of the abdominal wall. Some causes are always short-term (acute), and others can become long-lasting (chronic) unless successfully treated.
Sometimes, no cause can be found.
Experts don't yet understand all possible causes of pelvic pain, especially when it has become chronic. So even after a lot of testing, many women never find out the reason for their pain.
One reason might be what's called neuropathic pain. Long after a disease or injury
has healed, nerves can continue firing pain signals. This is thought to be caused by an
overloading of the
nervous system by extreme or long-lasting pain.
Not finding a cause doesn't mean that there isn't one or that there's no possible treatment.
Although the link isn't well understood, past or current abuse is strongly linked to chronic pelvic pain.
Female pelvic pain symptoms can include:
Depression symptoms are commonly linked
to chronic pain. Signs of depression include:
For the best chance
of recovery from pain, depression must be treated along with any known physical
causes of pain.
It can sometimes be hard to know how long pelvic pain will last and how best to treat it. It's a little different for every woman. But in general:
Symptoms often go away without treatment
menopause occurs and the ups and downs of hormone levels settle down.
If you are close to menopause (usually around age 50) and your symptoms are likely related to hormones, your best option may be home treatment and medicine while you wait for menopause.
The hormone changes of menopause may get rid of your chronic pain, but the pain may come back if you use
hormone replacement therapy. If you are nearing menopause, talk with your doctor about your options.
Risk factors are things that increase your chances of getting a certain condition or disease. Risk factors for pelvic pain that becomes chronic include:
Call a doctor for immediate care if
you have sudden,
severe pelvic pain, with or without vaginal bleeding.
Watchful waiting is a period of time during
which you and your doctor watch your pelvic pain symptoms
without using medical treatment.
During this period, you can keep a
daily record of your symptoms and menstrual cycle and any other life events that
you consider important. A watchful waiting period may last from a few days to
weeks or possibly months.
The following primary health professionals can
generally evaluate and help you manage the symptoms of female pelvic
For advanced treatment methods,
gynecologist or a urologist who specializes in female
If you have ever been physically
or sexually abused, that trauma may
be playing a part in your pain. So you'll need to let your doctor know about the abuse. This may be hard for you, but it may be easier if you find a doctor you feel comfortable talking to.
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Although your condition may be diagnosed during your first exam, don't be surprised if you need to 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.
Even if tests don't find any problems, it doesn't mean that there's no physical cause for your chronic pain. Tests aren't yet able to detect all causes.
It's a good idea to make a calendar or diary of your symptoms, menstrual cycle,
sexual activity, and physical exertion. And keep track of any other things that you think are
important, such as stressful events or illnesses. Bring it with you when you see your doctor.
To begin narrowing down the
list of possible causes of your pain, your doctor will review your
symptom diary and:
You may also have tests, such as:
Sometimes more tests are needed. Your doctor may recommend one or more of the following:
Chronic pain can have a
wearing effect on the mind and emotions, which can in turn make harder to manage pain.
Your doctor may recommend a
mental health assessment. You'll be asked questions
to find out whether such conditions as
insomnia, or stress are adding to or being
caused by your chronic pain.
For the best chance of recovering from pain, you will need treatment for emotional problems like these, plus treatment for any known physical causes of pain.
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. When it's possible, your doctor will do both.
Depending on the cause,
treatment may include:
Finding a treatment that works may take a while. It's common for women to try many treatments before finding one or more that help.
Medicines that may help manage your pain include:
Counseling and mental skills training, such as cognitive-behavioral therapy, help you manage your pain and the stress that makes it worse. For more information, see Other Treatment.
Alternative pain treatments that may help you manage pain include such things as acupuncture and transcutaneous nerve stimulation (TENS). For more information, see Other Treatment.
If your chronic pain hasn't responded to treatment or seems
to have no physical cause, you may have neuropathic pain. This means
that your nerves still create 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.
Decisions are complicated when you are considering treatment for chronic pelvic
pain. Think about these questions, and talk to your doctor about them:
Early diagnosis and treatment of pelvic pain
may help keep the pain from becoming chronic.
of chronic pelvic pain is
pelvic inflammatory disease. You can greatly lower your risk of getting this disease by practicing safe sex. Safe sex includes using condoms and using them correctly.
You can try these steps at home to ease pelvic pain:
Medicine won't cure
female pelvic pain. But it can help control the pain and keep it from getting worse or becoming chronic. There is no one medicine that works for all women.
Surgery is most likely to help when it's done for a specific condition, such as
Hysterectomy, the removal of
the uterus, is sometimes used as a last-resort treatment. Depending on the cause, hysterectomy may relieve pain for some
Studies have shown that surgery to remove scar tissue
adhesions from previous surgery or from
pelvic inflammatory disease doesn't relieve pain
unless the adhesions are severe.1
Surgery to remove reproductive organs may also help when
the cause of pain can't 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. And it can have serious side effects that you need to consider.
Laparoscopy to diagnose chronic pelvic pain may be done before other treatment. Areas of endometriosis
or scar tissue may be removed or destroyed during the
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 below. Combining your
medical treatment with these practices can help you keep a positive state of mind.
Counseling and mental skills training help you learn the mental and emotional tools for managing
chronic pain and the stress that makes it worse. Combining
medical and psychological treatment increases your chances of treatment
Commonly used treatments include:
For more information, see the topic
Physical therapy can help
you learn specific exercises to stretch and strengthen certain muscle groups.
This helps you to improve posture, gait,
and muscle tone.
Alternative pain treatments for chronic female pelvic pain aren't well studied. But they are
considered helpful for managing stress and building mental mastery over pain.
transcutaneous nerve stimulation (TENS) have shown
some success in relieving painful menstrual periods. Acupuncture has also been
used as a treatment for nonmenstrual chronic pelvic pain, but it isn't yet well
Other low-risk alternative pain
treatments that many people use to help manage pain include:
American Congress of Obstetricians and Gynecologists
(ACOG) is a nonprofit organization of professionals who provide health care for
women, including teens. The ACOG Resource Center publishes manuals and patient
education materials. The Web publications section of the site has patient
education pamphlets on many women's health topics, including reproductive
health, breast-feeding, violence, and quitting smoking.
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.
The Office on Women's Health is a service of the U.S. Department of Health and Human Services. It provides women's health information to a variety of
audiences, including consumers, health professionals, and researchers.
CitationsAmerican College of Obstetricians and Gynecologists
(2004, reaffirmed 2010). Chronic pelvic pain. ACOG Practice Bulletin No. 51.
Obstetrics and Gynecology, 103(3): 589–605.Engeler D, et al. (2012). Guidelines on Chronic Pelvic Pain. Arnhem, The Netherlands: European Association of Urology. Available online: http://www.uroweb.org/guidelines/online-guidelines.
February 17, 2012
Sarah Marshall, MD - Family Medicine & Kirtly Jones, MD - Obstetrics and Gynecology
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