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Pelvic Pain in Women: Causes, Treatment & Relief Strategies

pelvic pain Jan 13, 2026

Last Updated: January 2026 | By Heather Marra, PT, MPT, PRPC, PCES, CAPP

"I have pain in my pelvic area and I don't know where it's coming from." If you've said this to yourself, you're far from alone. Approximately 25 million women in the United States experience pelvic pain, affecting up to 1 in 7 women of reproductive age. Despite how common it is, pelvic pain often feels invisible—you look fine on the outside, but you're dealing with symptoms that significantly limit your life.

As a pelvic floor physical therapist who has worked with countless women experiencing pelvic pain, I understand how frustrating and isolating this condition can be. The good news? You don't have to suffer in silence, and there are effective treatments available.

In this comprehensive guide, you'll learn:

What pelvic pain is and where it can occur
Common causes of both acute and chronic pelvic pain
How to recognize warning signs requiring immediate medical attention
Effective treatment options including pelvic floor physical therapy
Specific exercises and self-care strategies for relief
Why pelvic floor muscle tension is often the culprit
When and how to seek professional help

What Is Pelvic Pain?

Pelvic pain refers to discomfort felt anywhere in your pelvic region—the area between your belly button and your upper thighs. This expansive region houses your reproductive organs, bladder, intestines, and the complex network of muscles, ligaments, and nerves that support these structures.

Where pelvic pain can occur:

Lower abdomen: Below the belly button
Pelvic floor: The "hammock" of muscles at the base of your pelvis
Pubic symphysis: The joint at the front of your pelvis
Groin: Where your legs meet your pelvis
Hips: Pain radiating to one or both hips
Lower back and sacroiliac (SI) joints: The joints connecting your spine to your pelvis
Tailbone (coccyx): The small bone at the base of your spine
Vagina or vulva: Pain during or separate from sexual activity

Types of pelvic pain:

Acute pelvic pain:

Sudden onset
Severe intensity
Usually has an identifiable cause
May signal a medical emergency
Examples: Ruptured ovarian cyst, ectopic pregnancy, appendicitis

Chronic pelvic pain (CPP):

Lasts 6 months or longer
May be constant or intermittent
Can be mild to severe
Often has multiple contributing factors
May continue even after initial cause is treated

The invisible burden:

One of the most challenging aspects of pelvic pain is that you can't see it. Friends, family, even healthcare providers may not fully understand the impact on your daily life. You might look perfectly healthy while struggling with:

Difficulty sitting for extended periods
Pain during or after sexual activity
Challenges with exercise or physical activity
Problems with bladder or bowel function
Disrupted sleep
Inability to work effectively
Strained relationships
Reduced quality of life

Common Causes of Pelvic Pain in Women

Pelvic pain can stem from numerous sources—reproductive, digestive, urinary, musculoskeletal, or neurological. Often, multiple factors contribute simultaneously, making diagnosis and treatment complex.

Gynecological Causes

Endometriosis:

Tissue similar to uterine lining grows outside the uterus
Affects up to 10% of women of reproductive age
Causes cyclic pain (often worsening with menstruation)
Can cause painful intercourse, painful bowel movements
Associated with infertility in 30-50% of cases

Adenomyosis:

Uterine lining grows into the muscular wall of the uterus
Causes heavy, painful periods
Pelvic pressure and bloating
More common in women over 30

Uterine fibroids:

Noncancerous tumors in or on the uterus
Can cause pelvic pressure, pain, heavy bleeding
Size and location determine symptoms
Very common (affecting 70-80% of women by age 50)

Ovarian cysts:

Fluid-filled sacs on or in the ovaries
Often benign and resolve on their own
Can cause pain if they rupture, twist, or grow large
Sudden severe pain may indicate torsion (medical emergency)

Pelvic inflammatory disease (PID):

Infection of reproductive organs
Usually caused by untreated STIs (chlamydia, gonorrhea)
Can cause long-term pelvic pain even after infection clears
May lead to scarring and fertility issues

Painful menstruation (dysmenorrhea):

Primary: No underlying condition, caused by prostaglandins
Secondary: Caused by endometriosis, fibroids, or other conditions
Affects up to 90% of women at some point

Pelvic Floor Muscle Dysfunction

This is where my expertise as a pelvic floor physical therapist becomes especially relevant.

Your pelvic floor is a group of muscles that form a supportive hammock at the base of your pelvis. These muscles:

Support your bladder, uterus, and rectum
Control urination and bowel movements
Play a role in sexual function
Stabilize your core and pelvis

Pelvic floor muscle dysfunction causes:

Hypertonic (high-tone) pelvic floor:

Muscles are too tight, can't relax properly
Creates chronic tension and pain
Often feels like constant pressure or aching
Can cause pain with sitting, sexual activity, bowel movements
Kegels may worsen symptoms (more on this later!)

Trigger points (muscle knots):

Just like you can have knots in your neck or shoulders, you can have trigger points in pelvic floor muscles
Create localized or referred pain
Can cause urinary urgency, frequency, or difficulty starting flow
May contribute to painful intercourse

Pelvic floor weakness (hypotonic):

Muscles are too weak to provide adequate support
Can occur alongside tightness in different muscle groups
May cause pelvic organ prolapse symptoms
Often accompanies stress urinary incontinence

Pregnancy and childbirth-related pain:

Vaginal delivery trauma (tearing, episiotomy)
C-section recovery and scar tissue
Muscle strain from pregnancy weight
Postpartum healing and adaptation
Diastasis recti (abdominal separation)

[Link to postpartum pelvic floor article]

Urological Causes

Interstitial cystitis / Bladder pain syndrome:

Chronic bladder inflammation
Causes pelvic pain, urinary urgency, frequency
No infection present
More common in women
Often coexists with other pain conditions

Urinary tract infections (UTIs):

Bacterial infection of urinary system
Burning with urination, pelvic pain
Urgency and frequency
Sometimes causes lower back pain
Recurrent UTIs can lead to chronic pain

Kidney stones:

Can cause severe pelvic and lower back pain
Pain often radiates from back to front
May cause blood in urine, nausea

Gastrointestinal Causes

Irritable bowel syndrome (IBS):

Affects 10-15% of the population
Causes abdominal pain, bloating, altered bowel habits
Commonly coexists with chronic pelvic pain
Stress and diet can trigger symptoms

Chronic constipation:

Straining can weaken pelvic floor muscles
Creates pelvic pressure and discomfort
Can worsen other pelvic pain conditions
May contribute to pelvic organ prolapse

[Link to constipation during pregnancy article]

Inflammatory bowel disease (IBD):

Crohn's disease or ulcerative colitis
Causes abdominal pain, diarrhea, weight loss
Chronic inflammation can affect pelvic area

Musculoskeletal Causes

Abdominal wall pain (myofascial pain):

Muscle or fascia tension in abdominal wall
Often from poor posture, repetitive strain
Can mimic internal organ pain
Responds well to physical therapy

Hip dysfunction:

Hip labral tears, arthritis, bursitis
Can refer pain to pelvic region
Affects gait and pelvic alignment
May require orthopedic intervention

Sacroiliac (SI) joint dysfunction:

Inflammation or misalignment of SI joints
Common during and after pregnancy
Causes lower back and pelvic pain
Often one-sided initially

Coccyx (tailbone) pain:

From falls, traumatic delivery, prolonged sitting
Makes sitting very uncomfortable
Can require specialized cushions or therapy

Nerve-Related Causes

Pudendal neuralgia:

Compression or damage to pudendal nerve
Causes burning, shooting, or electric-shock-like pain
Worse with sitting, better with standing
Can affect sexual function

Nerve entrapment:

Surgical scars can trap nerves
Previous surgeries (C-section, hernia repair, etc.)
Causes localized sharp or burning pain
May require specialized treatment

Psychological Factors

It's crucial to understand that chronic pain has both physical and psychological components. This doesn't mean pain is "all in your head"—it's very real. However:

Stress, anxiety, and depression:

Can amplify pain perception
Create muscle tension
Affect how the nervous system processes pain signals
Common in women with chronic pelvic pain

History of trauma:

Physical, emotional, or sexual trauma
Strongly associated with chronic pelvic pain
May require trauma-informed care
Counseling can be an important part of treatment

Central sensitization:

Nervous system becomes hypersensitive to pain
Can occur after prolonged chronic pain
Brain and nerves amplify pain signals
Requires specialized pain management approach

Understanding Chronic Pelvic Pain (CPP)

Definition: Pain lasting 6 months or longer in the pelvic region

Chronic pelvic pain affects approximately 15-20% of women of reproductive age—that's 1 in 7 women. Despite how common it is, CPP is often underdiagnosed and undertreated.

Characteristics of CPP:

May be constant or intermittent
Can vary in intensity (mild to severe)
May worsen with specific activities (sex, sitting, exercise)
Often has multiple contributing factors
Significantly impacts quality of life

Why CPP is complex:

Unlike acute pain that signals injury or illness, chronic pelvic pain often persists even after the initial cause has healed. This happens because:

Multiple factors contribute: You may have endometriosis + IBS + pelvic floor dysfunction all at once
Central sensitization develops: Your nervous system becomes more sensitive over time
Muscle patterns persist: Protective muscle guarding becomes habitual
Psychological factors develop: Chronic pain affects mood, sleep, stress levels
Fear-avoidance cycle: Pain leads to avoiding activities, which worsens function

The CPP diagnosis challenge:

In many cases (some studies suggest up to 60%), doctors can't identify a single, specific cause for chronic pelvic pain. This can be incredibly frustrating. However, your pain is real even when tests come back normal. The lack of identifiable pathology doesn't mean there's nothing wrong—it often means the pain involves:

Pelvic floor muscle dysfunction
Central sensitization
Multiple minor contributing factors
Functional rather than structural problems

This is where pelvic floor physical therapy becomes especially valuable.

When Kegels Make Pelvic Pain Worse

This is one of the most important things I want you to understand: Kegels don't fix every pelvic floor problem. In fact, for many women with pelvic pain, Kegels make things worse.

Why Kegels can worsen pain:

If your pelvic floor muscles are already too tight (hypertonic), doing Kegels is like trying to strengthen muscles that are already in spasm. Imagine having a Charlie horse in your calf and doing calf raises—it would hurt more, not less!

Signs your pelvic floor might be too tight:

Pelvic pain that worsens with Kegels
Difficulty starting urination
Feeling like you can't fully empty your bladder or bowels
Painful sexual intercourse
Constipation
Tailbone pain
Sitting intolerance

What you need instead of Kegels:

Relaxation and lengthening exercises: Teaching muscles to let go
Breathing exercises: Diaphragmatic breathing promotes pelvic floor relaxation
Stretching: Gentle stretches for hip, glute, and inner thigh muscles
Manual therapy: Specialized techniques from a pelvic floor PT
Posture correction: Reducing unnecessary muscle tension
Stress management: Addressing the mind-body connection

This is why it's so important to see a pelvic floor physical therapist before assuming you need to strengthen. You may need the opposite approach!

Warning Signs: When to Seek Immediate Medical Attention

While most pelvic pain, though uncomfortable, isn't an emergency, certain symptoms require urgent evaluation:

Call 911 or Go to the Emergency Room If You Experience:

🚨 Sudden, severe pelvic pain

Especially if accompanied by nausea, vomiting, or fainting
Could indicate ectopic pregnancy, ovarian torsion, or ruptured cyst

🚨 Pelvic pain with pregnancy signs

Missed period + severe pelvic pain
Could indicate ectopic pregnancy (life-threatening)

🚨 Heavy vaginal bleeding

Soaking through a pad per hour
Passing large clots
Especially concerning if pregnant or could be pregnant

🚨 High fever (over 101°F) with pelvic pain

Could indicate serious infection (PID, appendicitis, sepsis)
Especially if accompanied by chills, nausea, or vomiting

🚨 Inability to urinate or have a bowel movement

Could indicate obstruction
Severe bloating with inability to pass gas

🚨 Signs of shock

Rapid heartbeat, dizziness, confusion
Cold, clammy skin
Rapid breathing

Schedule an Appointment with Your Doctor Soon If You Have:

New pelvic pain that persists more than a few days
Pain that's gradually worsening
Pain interfering with daily activities
Painful intercourse (dyspareunia)
Changes in bowel or bladder function
Abnormal vaginal bleeding or discharge
Pain that returns after previous treatment
Concerns about symptoms

Don't wait for pain to become unbearable. Early intervention often leads to better outcomes.

Diagnosing Pelvic Pain: What to Expect

Getting an accurate diagnosis is the first step toward effective treatment. Here's what you can expect:

Medical History

Your healthcare provider will ask detailed questions about:

Pain characteristics: Location, intensity (on a scale of 1-10), quality (sharp, dull, burning, aching)
Timing: When it started, constant vs. intermittent, relationship to menstrual cycle
Triggers: What makes it better or worse (position, activity, eating, bowel/bladder function)
Associated symptoms: Bleeding, discharge, bowel changes, urinary symptoms
Impact on life: Effect on work, sleep, relationships, sexual function
Medical history: Previous surgeries, pregnancies, infections, injuries
Trauma history: Previous pelvic trauma or abuse (asked sensitively)

Tip: Keep a pain diary for a week or two before your appointment. Note when pain occurs, its intensity, what you were doing, and any associated symptoms. This information is incredibly valuable.

Physical Examination

Abdominal examination:

Palpation to check for masses, tenderness, muscle tension
Assessment of surgical scars
Evaluation for hernias

Pelvic examination:

External inspection
Speculum exam to visualize cervix and vagina
Bimanual exam to assess uterus and ovaries
Assessment for pelvic organ prolapse
Evaluation of pelvic floor muscle tone and tenderness

Musculoskeletal assessment:

Posture evaluation
Hip range of motion
Lower back and SI joint assessment
Abdominal wall muscle check
Sometimes includes rectal exam to assess pelvic floor muscles

Diagnostic Tests

Depending on your symptoms, your provider may order:

Laboratory tests:

Pregnancy test
Urine analysis (check for infection, blood)
STI screening (chlamydia, gonorrhea)
Blood work (complete blood count, inflammatory markers)

Imaging:

Pelvic ultrasound: First-line imaging for gynecologic issues
Transvaginal ultrasound: Better visualization of ovaries, uterus
CT scan: For suspected appendicitis, kidney stones, or other urgent concerns
MRI: Detailed imaging for endometriosis, adenomyosis, or complex cases

Specialized procedures:

Laparoscopy: Minimally invasive surgery to directly visualize pelvic organs, diagnose endometriosis
Cystoscopy: Camera into bladder to check for interstitial cystitis
Colonoscopy: Examine colon for digestive causes

Important to know: Many women with chronic pelvic pain have normal test results. This doesn't mean the pain isn't real or that nothing can be done. It often means pelvic floor muscle dysfunction is the primary issue—which doesn't show up on standard tests but can be identified by a skilled pelvic floor physical therapist.

Comprehensive Treatment Options for Pelvic Pain

Effective treatment for pelvic pain often requires a multimodal approach—combining several therapies to address different contributing factors.

Pelvic Floor Physical Therapy

This is my area of expertise, and I consider it one of the most effective treatments for many types of pelvic pain.

A pelvic floor physical therapist specializes in evaluating and treating the muscles, nerves, and connective tissues of the pelvic region.

What happens in pelvic floor PT:

Initial evaluation (60-90 minutes):

Comprehensive history
Posture and movement assessment
External musculoskeletal exam
Internal pelvic floor muscle assessment (with your consent)
Identification of trigger points, muscle tension, weakness
Development of personalized treatment plan

Treatment techniques may include:

Manual therapy:

Internal and external myofascial release
Trigger point release
Scar tissue mobilization
Joint mobilization (hips, SI joints)
Visceral mobilization

Therapeutic exercises:

Pelvic floor relaxation techniques (down-training)
Breathing exercises
Stretching for hip, glute, and core muscles
Strengthening when appropriate (not always Kegels!)
Postural exercises
Movement re-education

Modalities:

Biofeedback (visual feedback of muscle activity)
Electrical stimulation
Heat/cold therapy
Dilator therapy (for painful intercourse)
TENS unit for pain management

Education:

Bladder and bowel habits
Positioning for daily activities
Pain science education
Self-care strategies

Typical treatment course:

Usually 6-12 sessions over 8-16 weeks
Frequency depends on severity
Home exercise program between sessions
Progress monitored and plan adjusted

[Link to what to wear to pelvic floor therapy article]

Medical Treatments

Pain medications:

NSAIDs: Ibuprofen, naproxen for inflammation and pain
Acetaminophen: For pain without inflammation
Muscle relaxants: For muscle spasm
Nerve pain medications: Gabapentin, pregabalin for neuropathic pain
Low-dose antidepressants: Can help with chronic pain (tricyclics, SNRIs)

Important: Opioids are generally not recommended for chronic pelvic pain due to limited effectiveness and addiction risk.

Hormonal treatments:

Birth control pills: Suppress menstruation for endometriosis, dysmenorrhea
Progestin therapy: IUD, injection, or pills
GnRH agonists: Suppress hormones for endometriosis (short-term use)

Antibiotics:

For confirmed infections (PID, UTIs)
Must complete full course

Bladder medications:

For interstitial cystitis/bladder pain syndrome
Examples: Elmiron, antihistamines

Surgical Interventions

Surgery is typically considered when:

Conservative treatments haven't worked
There's a specific structural problem
Quality of life is severely impacted

Procedures may include:

Laparoscopy for endometriosis excision
Fibroid removal (myomectomy)
Ovarian cyst removal
Nerve blocks or ablation
Hysterectomy (last resort, only if not desiring future pregnancy)

Important: Surgery should rarely be the first treatment for chronic pelvic pain. Studies show that hysterectomy resolves CPP in only about 30-50% of cases. Always try conservative treatments first.

Complementary Therapies

Counseling/Therapy:

Cognitive behavioral therapy (CBT) for pain management
Trauma-focused therapy if abuse history
Sex therapy for pain during intercourse
Couples counseling for relationship strain

Mind-body techniques:

Meditation and mindfulness
Yoga (therapeutic, not power yoga)
Guided imagery
Progressive muscle relaxation
Biofeedback

Acupuncture:

May help some women with pain relief
Best used as complementary therapy
Seek licensed, experienced practitioners

Nutrition:

Anti-inflammatory diet for some conditions
Fiber for constipation-related pain
Bladder-friendly diet for IC/BPS
Working with a registered dietitian

Lifestyle Modifications

Activity pacing:

Balance activity with rest
Avoid boom-bust cycles (doing too much on good days)
Gradual return to activities you enjoy

Stress management:

Critical for pain management
Regular relaxation practice
Adequate sleep
Social support

Ergonomic adjustments:

Proper sitting posture
Supportive chairs
Cushions if needed
Workstation modifications

Effective Home Exercises for Pelvic Pain Relief

Important: These are general exercises that help many women with pelvic pain. However, everyone's situation is different. If any exercise increases your pain, stop and consult a pelvic floor physical therapist.

Relaxation and Breathing

Diaphragmatic Breathing (5-10 minutes, 2-3x daily):

Lie on your back with knees bent, feet flat
Place one hand on your chest, one on your belly
Breathe in slowly through your nose, expanding your belly (not chest)
Exhale slowly through your mouth, belly falls
Focus on relaxing your pelvic floor as you exhale
Imagine your pelvic floor gently opening and softening

Why it helps: Activates the parasympathetic nervous system, promotes pelvic floor relaxation, reduces overall muscle tension.

[Link to diaphragmatic breathing article]

Stretching Exercises

Double Knee to Chest:

Lie on your back
Gently pull both knees toward your chest
Hold for 15-30 seconds, breathing normally
Feel a gentle stretch in your lower back and hips
Release slowly
Repeat 3-5 times
Do 1-2 times daily

If this causes pain, don't force it. Stop and try a gentler approach.

Deep Squat (Happy Baby Variation):

Squat down, keeping heels on ground if possible
Place elbows inside knees
Gently press knees apart with your elbows
Hold for 15-30 seconds
Breathe deeply, relaxing pelvic floor
Stand up slowly
Repeat 3-5 times

Modification: If you can't squat fully, do this against a wall or holding onto a counter for support.

Child's Pose:

Kneel on floor (use padding if needed)
Sit back on your heels
Reach arms forward, lowering chest toward floor
Rest forehead on ground or on stacked hands
Breathe deeply for 30-60 seconds
Feel gentle stretch in lower back, hips, pelvic floor
Repeat as feels good

Figure 4 Stretch (Piriformis Stretch):

Lie on back, knees bent
Cross right ankle over left knee (making a "4" shape)
Reach through and clasp hands behind left thigh
Gently pull left thigh toward chest
Feel stretch in right hip/glute
Hold 30 seconds
Repeat other side
Do 2-3 times per side, 1-2x daily

Mobility Exercises

Cat-Cow (Pelvic Tilts on hands and knees):

Position on hands and knees (tabletop position)
Hands under shoulders, knees under hips
Inhale: Let belly drop, lift chest and tailbone (Cow)
Exhale: Round spine, tuck tailbone, drop head (Cat)
Move slowly between positions 10-15 times
Do 1-2x daily

Why it helps: Mobilizes spine and pelvis, promotes pelvic floor movement, gentle core engagement.

Pelvic Circles:

Stand with feet hip-width apart, hands on hips
Gently circle hips clockwise 10 times
Then counterclockwise 10 times
Keep movements smooth and controlled
Do several times throughout the day

What NOT to Do

❌ Avoid forcing any stretch that increases pain
❌ Don't do Kegels if you have hypertonic pelvic floor (tight muscles)
❌ Avoid high-impact exercise until cleared by your provider
❌ Don't push through sharp pain (this is different from gentle stretch sensation)
❌ Don't hold your breath during exercises

When to seek professional guidance:

If you're unsure which exercises are right for you, experiencing increased pain, or not seeing improvement after 2-3 weeks of consistent gentle exercise, it's time to see a pelvic floor physical therapist. They can assess your specific situation and create a customized program.

Living with Chronic Pelvic Pain: Coping Strategies

If you're dealing with chronic pelvic pain, these strategies can help improve your quality of life:

Pain Management Techniques

Pacing:

Balance activity with rest
Break tasks into smaller chunks
Use timers to remind yourself to change positions
Plan more demanding activities for times when pain is typically lower

Heat/Cold therapy:

Heating pad on low setting for 15-20 minutes
Warm bath (not too hot)
Ice pack for acute flare-ups
Never apply heat or ice directly to skin

Relaxation techniques:

Progressive muscle relaxation
Guided imagery
Meditation apps (Headspace, Calm, Insight Timer)
Gentle yoga or tai chi

Maintaining Relationships

Communication with partner:

Be open about your pain and limitations
Discuss modifications for sexual activity
Focus on intimacy beyond intercourse
Consider couples counseling if needed

[Link to sex after baby article]

Social connections:

Don't isolate yourself
Explain your condition to close friends/family
Join support groups (online or in-person)
Accept help when offered

Work and Daily Life

Workplace modifications:

Ergonomic chair or cushion
Standing desk option
Regular movement breaks
Communicate needs with employer (may qualify for accommodations)

Self-care priorities:

Sleep hygiene
Stress management
Nutritious diet
Gentle movement
Activities you enjoy

Advocate for yourself:

You know your body best
If a provider dismisses your concerns, seek a second opinion
Keep records of symptoms, treatments tried
Don't give up on finding the right help

The Importance of Finding the Right Healthcare Team

You deserve providers who:

Listen to your concerns without dismissing them
Believe your pain is real
Take a comprehensive approach
Are willing to work with other specialists
Support your treatment preferences

Your care team might include:

Gynecologist or urogynecologist
Pelvic floor physical therapist
Pain management specialist
Gastroenterologist
Urologist
Mental health professional
Registered dietitian

Don't settle for "it's just stress" or "learn to live with it."

Pelvic pain is complex, but it's treatable. If you've been suffering for months or years, please know that help is available. I've seen countless women regain their quality of life through appropriate treatment—and you can too.

Frequently Asked Questions About Pelvic Pain

Q: What causes pelvic pain in women?

Pelvic pain in women can stem from numerous sources including gynecological conditions (endometriosis, fibroids, ovarian cysts), pelvic floor muscle dysfunction, urological issues (interstitial cystitis, UTIs), gastrointestinal problems (IBS, constipation), musculoskeletal dysfunction, and nerve issues. Often, multiple factors contribute simultaneously. Approximately 50-90% of women with chronic pelvic pain have some degree of pelvic floor muscle dysfunction.

Q: When should I worry about pelvic pain?

Seek immediate medical attention for sudden severe pain, pain with pregnancy signs, heavy vaginal bleeding, high fever with pain, or inability to urinate or have bowel movements. Schedule a doctor's appointment soon for new persistent pain, gradually worsening symptoms, pain interfering with daily activities, painful intercourse, or changes in bowel/bladder function. Don't wait for pain to become unbearable—early intervention often leads to better outcomes.

Q: Can pelvic floor dysfunction cause pain?

Yes, absolutely. Pelvic floor muscle dysfunction is one of the most common causes of chronic pelvic pain, present in 50-90% of cases. When pelvic floor muscles are too tight (hypertonic), have trigger points, or don't relax properly, they can cause constant or intermittent pelvic pain, pain with sitting, painful intercourse, urinary symptoms, and bowel dysfunction. A pelvic floor physical therapist can assess and treat this type of dysfunction effectively.

Q: How is chronic pelvic pain diagnosed?

Diagnosis involves a comprehensive medical history, physical examination (including pelvic and sometimes rectal exam), and potentially diagnostic tests like ultrasound, blood work, urinalysis, or STI screening. In many cases (up to 60%), standard tests come back normal because the pain involves pelvic floor muscle dysfunction or central sensitization rather than identifiable structural problems. This doesn't mean the pain isn't real—it means specialized evaluation by a pelvic floor physical therapist may be needed.

Q: What is pelvic floor physical therapy?

Pelvic floor physical therapy is specialized treatment performed by physical therapists with advanced training in pelvic health. Treatment includes internal and external assessment of pelvic floor muscles, manual therapy to release muscle tension and trigger points, therapeutic exercises (often focusing on relaxation rather than strengthening), breathing techniques, posture correction, and education. Most courses involve 6-12 sessions over 8-16 weeks and are highly effective for many types of pelvic pain.

Q: Why do Kegels make my pelvic pain worse?

If your pelvic floor muscles are already too tight (hypertonic), doing Kegels—which involve contracting these muscles—can make pain worse. It's like trying to strengthen muscles that are already in spasm. Many women with pelvic pain need pelvic floor relaxation and lengthening exercises instead of strengthening. This is why it's crucial to see a pelvic floor physical therapist who can assess your muscle tone before prescribing Kegel exercises.

Q: Can endometriosis be diagnosed without surgery?

While symptoms, physical exam findings, and imaging (especially MRI) can strongly suggest endometriosis, definitive diagnosis traditionally requires laparoscopy (minimally invasive surgery) with biopsy. However, many doctors now treat suspected endometriosis based on symptoms and imaging without requiring surgery, especially if you respond well to hormonal treatment. Discuss with your gynecologist which approach makes sense for your situation.

Q: Is chronic pelvic pain curable?

While "cure" varies depending on the underlying cause, chronic pelvic pain is highly treatable. With appropriate multidisciplinary care—including pelvic floor physical therapy, pain management, treatment of any underlying conditions, and lifestyle modifications—most women experience significant improvement in pain and quality of life. The key is not giving up and working with providers experienced in treating chronic pelvic pain.

Q: Will I need surgery for pelvic pain?

Most pelvic pain can be managed without surgery through conservative treatments like pelvic floor physical therapy, medications, lifestyle modifications, and counseling. Surgery may be appropriate for specific conditions like large fibroids, severe endometriosis, or ovarian masses, but should rarely be the first treatment. Studies show that hysterectomy only resolves chronic pelvic pain in about 30-50% of cases, so always try conservative approaches first.

Q: How long does it take to see improvement with treatment?

This varies significantly depending on how long you've had pain and what's causing it. With pelvic floor physical therapy, many women notice some improvement within 4-6 sessions (about 4-8 weeks), with continued improvement over 3-6 months. Medications may work faster or slower depending on type. The key is giving treatments adequate time to work while staying in communication with your providers about your progress.

The Bottom Line: You Don't Have to Suffer in Silence

If you're experiencing pelvic pain—whether it's been a few weeks or many years—please know that you're not alone, and you don't have to continue suffering. While pelvic pain is complex and can be challenging to diagnose and treat, effective solutions exist.

Key takeaways: ✅ Pelvic pain affects 1 in 7 women—it's incredibly common
✅ Pain can have multiple contributing factors simultaneously
✅ Pelvic floor muscle dysfunction is present in 50-90% of cases
✅ Your pain is real even if tests come back normal
✅ Kegels aren't always the answer—sometimes muscles need to relax, not strengthen
✅ Pelvic floor physical therapy is highly effective for many types of pelvic pain
✅ A multidisciplinary approach often works best
✅ Early intervention typically leads to better outcomes
✅ Don't give up if the first treatment doesn't work

I've worked with hundreds of women experiencing pelvic pain, and I've seen remarkable transformations when they receive appropriate, comprehensive care. The first step is seeking help—from your doctor, a pelvic floor physical therapist, or both.

You deserve to live without constant pain. You deserve providers who listen and believe you. You deserve to reclaim your quality of life.

Take one simple step today: Make an appointment. Your journey to relief starts now.

About the Author

Heather Marra, PT, MPT, PRPC, PCES, CAPP is a pelvic health physical therapist and Women's Health Specialist with over 25 years of experience helping women find relief from pelvic pain and pelvic floor dysfunction. She is passionate about empowering women with knowledge and providing compassionate, effective treatment to help them regain their quality of life.

Medical Disclaimer: This article is for educational purposes only and does not replace medical advice from your healthcare provider. Always consult your doctor or pelvic health specialist if you're experiencing pelvic pain or concerning symptoms.