Women's Health

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:

• Normal ovulation, which can cause brief ovary pain, or "mittelschmerz." This pain is cyclic, meaning that it happens once during each normal menstrual cycle.
• Ectopic pregnancy, which requires emergency treatment.
• Kidney stones, which can become chronic.
• Appendicitis, which requires immediate medical care.
• Functional ovarian cysts, which happen during a menstrual cycle.
• Urinary tract infection.
• Pelvic inflammatory disease (PID) or tubo-ovarian abscess, which requires medical treatment.
• Sexually transmitted infections.

Conditions that can cause chronic pelvic pain include:

• Endometriosis, the growth of uterine lining (endometrial) tissue outside of the uterus, which often causes cyclic pain and bleeding.
• Adenomyosis, the growth of endometrial tissue into the uterine muscle, which can cause cyclic pain and bleeding.
• Noncancerous (benign) tumors of the uterus, such as:
  • Uterine fibroids.
  • Endometrial polyps.
• Scar tissue (adhesions) in the abdomen and pelvis, typically caused by pelvic inflammatory disease, radiation treatment of the pelvis, or pelvic or abdominal surgery.
• Bowel problems, such as irritable bowel syndrome.
• Physical or sexual abuse in the recent or distant past. (Though poorly understood, combined emotional and physical trauma are thought to cause chronic pain or make it worse.¹)
• Urinary tract problems, such as bladder inflammation (chronic interstitial cystitis).
• Pelvic organ cancers.
• Structural problems with the uterus.
• Muscle spasm or pain in the lower abdominal wall muscles ("trigger points"). This is sometimes linked to past surgery in that area.
• Congestion of the pelvic veins.