Condition: Chronic Pelvic Pain - Females
Brief Overview: According to UpToDate, “While there is no consensus on the definition of CPP, it is generally defined as non-cyclic pain perceived to be in the pelvic area that has persisted for at least three to six months, or longer, and is unrelated to pregnancy.”
Prevalence: According to UpToDate, “Globally, female CPP has been reported to affect 6 to 25 percent of reproductive-age women.”
Etiology: There are many possible etiologies for chronic pelvic pain in females. Some of these are:
- Gynecologic causes: endometriosis, adhesions, prior PID, adenomyosis, fibroids, ovarian cysts, pelvic congestion.
- Urologic causes: interstitial cystitis / bladder pain syndrome
- GI causes: irritable bowel syndrome, inflammatory bowel disease, constipation, celiac disease
- Musculoskeletal: pelvic floor myofascial pain, fibromyalgia
- Psychosocial: history of trauma/abuse, anxiety, depression
- Some cancers/malignancies
Risk Factors:
- History of pelvic inflammatory disease or STIs
- Endometriosis or prior gynecologic conditions
- Pelvic floor dysfunction
- Recurrent UTIs or IC/BPS
- IBS or other GI disorders
- Sexual trauma or adverse childhood experiences
Commonly Associated Conditions:
- Endometriosis
- Interstitial cystitis / bladder pain syndrome
- IBS, IBD
- Celiac Disease
- Pelvic floor dysfunction
- Vulvodynia, dyspareunia
- Fibromyalgia
Common Medications: There isn’t a medications specifically for CPP. Medication will depend on the underlying etiology and symptoms.
Common Labs, Imaging, and Tests:
- Urinalysis, STI testing, pregnancy testing
- GI studies
- Imaging: Ultrasound, MRI, CT
- Laparoscopy
Common Symptoms:
- Non-cyclic pelvic pain
- Urinary symptoms
- Dyspareunia
- GI symptoms
- Decreased quality of life
- Depression, anxiety, increased stress
Common Treatments:
- Lifestyle & behavioral strategies: gentle stretching, heat therapy, bladder/bowel irritant avoidance, stress management.
- Pelvic floor physical therapy: addressing muscle tension, trigger points, and pelvic floor dysfunction.
- Pharmacologic therapy: NSAIDs, hormonal therapy, neuropathic agents, relaxants.
- Minimally invasive procedures: trigger point injections, nerve blocks.
- Multidisciplinary care: gynecology, urology, GI, behavioral health, pain management.
- Cognitive behavioral therapy (CBT) or trauma-informed therapy if indicated.
- Laparoscopy may be indicated
Physical Findings:
- Pelvic floor muscle tenderness
- Pain with bimanual exam
- Suprapubic or adnexal tenderness
- Normal or minimal imaging findings possible despite significant symptoms
Potential Complications and Contraindications:
- Sexual dysfunction
- Anxiety, depression, reduced quality of life
- Bladder or bowel dysfunction
- Chronic pain sensitization
- Misdiagnosis or delayed diagnosis
General Health and Lifestyle Guidance:
- Encourage regular follow-up with all healthcare providers, including gynecology, urology, or pelvic pain specialists.
- Promote pelvic floor relaxation strategies.
- Adequate hydration and balanced diet to minimize bladder/GI triggers.
- Stress management and mental health support.
- Warm compresses, heat therapy, and gentle movement may be helpful.
Suggested Questions to Ask Patients:
- How long have you had pelvic pain, and how would you describe it?
- Does pain occur in relation to your menstrual cycle?
- Are urinary or bowel symptoms present?
- Have you ever had pelvic infections or surgery?
- Does intercourse worsen your symptoms?
- Have you tried any physical therapy or medications?
- How is this pain affecting your quality of life?
Suggested Talking Points:
- Chronic pelvic pain is common and often involves multiple factors.
- Your treatment plan may involve a combination of approaches.
- Pelvic floor therapy and pain management can make a big difference.
- You may have several specialists to create the best plan for you.
- Always ask your healthcare provider for specific advice on when to call to report symptoms, and when to seek urgent/emergency care.
Sources:
- https://www.uptodate.com/contents/chronic-pelvic-pain-in-adult-females-evaluation?search=chronic%20pelvic%20pain%20syndrome%20adult&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2#H1123814595
- https://pelvicrehabilitation.com/conditions/chronic-pelvic-pain-syndrome-cpps/