Pelvic Pain That Won’t Go Away: When It’s Time to See a Specialist

Many women live with pelvic pain for years because no single episode ever seems bad enough to act on, and each doctor visit ends with some version of "everything looks normal." The American College of Obstetricians and Gynecologists (ACOG) estimates that as many as one in four women meet the definition of chronic pelvic pain. This post is about when pain stops being something to manage on your own and becomes something to get properly evaluated.

What makes pelvic pain "chronic"

ACOG’s patient guidance on chronic pelvic pain defines it as "pain in the pelvic area that lasts for 6 months or longer." The definition is broader than many people expect. ACOG notes that "pain does not have to happen every day for it to be considered chronic," and that chronic pain "can come and go, or it can be constant." Pain that shows up with your period, with bowel or bladder function, or during sexual activity, and has been doing so for half a year, counts.

You do not have to wait six months before seeing someone about pelvic pain. Newer pain is worth having checked too. Six months is simply the point at which ACOG classifies pelvic pain as chronic.

Pain that should not wait

Sudden pelvic pain is a different situation from the chronic kind. ACOG describes short-term, or acute, pelvic pain as something that "may be a warning of a problem that needs immediate medical care, such as infections, ectopic pregnancy, or an ovarian cyst that has twisted or ruptured." Severe pain that came on quickly, pelvic pain with a fever, or pelvic pain when there is any chance you are pregnant should be seen the same day. The rest of this post is about the slower, longer-lasting kind.

Why "everything looks normal" happens so often

Several different organ systems share the pelvis, which is a big part of why the cause can be hard to find. ACOG notes that some of the conditions behind chronic pelvic pain "may not be related to the reproductive organs but to the urinary tract or bowel." Possible sources range from endometriosis and fibroids to bladder pain syndrome, irritable bowel syndrome, and the muscles and nerves of the pelvic floor. ACOG’s clinical guidance for physicians recommends screening for bladder and bowel conditions, and for depression and anxiety, as part of the evaluation.

That is why a normal exam and a normal ultrasound can coexist with real, ongoing pain. Those tests find some causes well and can miss others entirely. ACOG’s patient guidance acknowledges that "sometimes no cause is found," and adds that "your pain is real even if an injury or disease cannot be found." In that case, treatment focuses on reducing the pain and its effect on your daily life.

A thorough evaluation will likely also ask about past trauma, and it helps to know why. ACOG reports that "about one-half of all women with chronic pelvic pain have a history of trauma," while also stressing that trauma is rarely the only cause and that physical causes should always be considered. Being asked about it is a standard part of a complete evaluation and does not mean the clinician has decided the pain is psychological.

When it is time to see a specialist

Any one of the following is reason enough to stop managing the pain on your own and have it evaluated.

1. The pain has lasted six months or more, including pain that only shows up with your cycle.
2. It is getting in the way of your life. ACOG notes that chronic pelvic pain "can disrupt work, physical activity, sexual relations, sleep, or family life." If yours is doing any of that, it is worth a closer look.
3. You have already been told everything looks normal, but the pain has not gone away. That is usually the point where a broader evaluation is worth pursuing.
4. You have tried the same treatment more than once without lasting relief. At that point it is worth asking what else could be driving the pain.
5. Surgery has been recommended, or already done, and you are unsure. That is a good time for a second opinion. We have written about second opinions for endometriosis and chronic pelvic pain and about what to ask before you commit to surgery.

What a specialist does differently

A specialist looks beyond a single organ system and a single test. Our approach to pelvic pain is multidisciplinary. It includes pelvic floor physical therapy, which ACOG recommends for the muscle-related side of chronic pelvic pain and which can be done from home. It also includes hormonal treatment where it fits the cause, a low-inflammatory diet, and behavioral and psychosocial support, including the kind of cognitive behavioral therapy ACOG recommends for chronic pelvic pain.

If surgery becomes necessary, our physicians stay involved as your advocates, hand-picking local sub-specialists and coordinating the treatment plan with them directly, so the physician who knows your whole history is still part of the decision.

Much of this work is conversation, history, and a careful review of your records, which a telehealth visit handles well. We also offer second opinions on pelvic pain diagnoses and surgical recommendations, built around the records you already have.

If this sounds like you

If you have been managing pelvic pain for six months or longer, or you have been told there is nothing to find, the next step is an evaluation that looks at the whole picture. Our board-certified physicians treat chronic pelvic pain through telehealth, with time set aside to take a full history and review what has already been done. Request a free consultation and bring your records if you have them. We would be happy to help you.