Chronic Female Pelvic Pain

If you have had pain below your belly button and it has lasted for 6 months or longer, you may have chronic female pelvic pain. The type, quality and exact location of pain varies. It may be simply a dull ache the occurs only some of the time, or it may be severe steady pain that impacts your sleep, work or your general daily routine. This topic describes some of the symptoms, possible causes and treatment options to discuss with your doctor.

What Are Symptoms of Chronic Female Pelvic Pain?

The type (dull to sharp), quality (mild to severe) and exact location of the pain vary widely, but some common symptoms include the following:

• Pain when urinating
• Painful bowel movements
• Painful sex
• Excessive menstrual cramping
• Pain when sitting or bending sharply at the waist

Chronic pain can be a significant cause of depression or anxiety, and should not be ignored.

What Causes Chronic Female Pelvic Pain?

All of the potential causes are not fully understood, but a common set of causes include:

• Scar tissue or adhesions in the pelvic area left after surgery or a pelvic infection
• Chronic bladder irritation
• Irritable bowel syndrome
• Other urinary tract or bowel diseases
• Uterine fibroids
• Ovarian remnants from a hysterectomy
• Endometriosis or adenomyosis
• Pelvic floor muscle spasm
• Interstitial Cystitis
• Physical abuse
• Sexual abuse

Physical and sexual abuse are associated with about half of the women who complain of chronic pelvic pain. The exact cause may be difficult to determine. This is complicated by the presence of neuropathic pain (affected nerves continuing to send pain after the cause is treated). If the cause can be found, treatment may make the pain go away. Even if no specific cause is found, you and your doctor can find ways to ease your pain.

Diagnosing Chronic Female Pelvic Pain

Your doctor will ask questions to determine your specific symptoms, your health history and other pertinent facts. A complete pelvic exam is usually conducted. Other tests may include a Pap test (for cell dysplasia), blood and urine tests (for infection), test for sexually transmitted diseases, and a pregnancy test.

These exams may be done on your first visit, and followed up by other tests as indicated. Finding the cause as accurately as possible will make it easier to ensure the most effective treatment and relief from your pain. Your doctor may ask questions about depression or stress because these can add to your symptoms. Follow-up tests may include an ultrasound, CT scan or MRI of your pelvis. A laparoscopy may be performed to look for scarring.

Treatment Options

Finding the exact cause of your pain may require trying more than one treatment. Common treatments include antibiotics (for infections), birth control pills or hormone treatment (for problems related to menstruation), or surgery (for removal of cysts or tumors). For cases where the exact cause is illusive, you will get the best results by participating with your doctor in trying a sequence of treatments and observing the results.