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Chronic Female Pelvic Pain

Chronic Female Pelvic Pain
This topic focuses on pelvic pain that has lasted longer than 6 months. If you have new, sudden pelvic pain, see your doctor as soon as you can.
What is chronic female pelvic pain?

Female pelvic pain is pain below a woman’s belly button. It is considered chronic, which means long-lasting, if you have had it for at least 6 months. The type of pain varies from woman to woman. In some women, it is a mild ache that comes and goes. In others, the pain is so steady and severe that it’s hard to sleep, work, or enjoy life.

If your doctor can find what’s causing the pain, treating the cause may make the pain go away. If no cause is found, your doctor can help you find ways to ease the pain and get your life back.

What causes chronic female pelvic pain?

Some common causes include:

Problems of the reproductive system, such as endometriosis, adenomyosis, and uterine fibroids.
Scar tissue (adhesions) in the pelvic area after a pelvic infection or surgery.
Diseases of the urinary tract or bowel, such as irritable bowel syndrome or chronic bladder irritation.
Physical or sexual abuse. Experts are not sure why this is so, but about half of women with chronic pelvic pain have a history of abuse.1
Doctors don't really understand all the things that can cause chronic pelvic pain. So sometimes, even with a lot of testing, the cause remains a mystery. This doesn't mean that there isn't a cause or that your pain isn't real.

Sometimes, after a disease has been treated or an injury has healed, the affected nerves keep sending pain signals. This is called neuropathic pain. It may help explain why it can be so hard to find the cause of chronic pelvic pain.

What are the symptoms?

The type of pain can vary widely. Chronic pelvic pain can include:

Pain that ranges from mild to severe.
Pain that ranges from dull to sharp.
Severe cramping during periods.
Pain during sex.
Pain when you urinate or have a bowel movement.
Chronic pain can lead to depression. Depression can cause you to feel sad and hopeless, eat and sleep poorly, and move slowly.

How is chronic female pelvic pain diagnosed?

At your first visit, your doctor will do a complete pelvic exam to look for problems with your reproductive system. The doctor will also ask questions about your past and present health and about your symptoms. You may have some tests, such as:

A Pap test to look for cervical cancer or cell changes called dysplasia.
Blood and urine tests to look for signs of infection.
A pregnancy test.
Tests for sexually transmitted infections.
Emotional issues can play a big role in chronic pain. Your doctor may ask questions to find out if depression or stress is adding to your problem. You may also be asked about any past or current sexual or physical abuse. It can be hard to talk about these things, but it’s important to do it so you can get the right treatment.

If the first tests don't find a cause, you may have other tests that show pictures of the organs in your belly. These may include a transvaginal ultrasound and an MRI or CT scan of the pelvis. You may also have a type of minor surgery called laparoscopy (say “lap-uh-ROS-kuh-pee”). In this surgery, the doctor puts a thin, lighted tube with a tiny camera through a small cut in your belly. This lets the doctor look for problems like growths or scar tissue inside your belly.

Finding the cause of pelvic pain can be a long and frustrating process. You can help by keeping notes about the type of pain you have, when it happens, and what seems to bring it on. Show these notes to your doctor. They may give clues about what is causing the problem or the best way to treat it.

How is it treated?

If your doctor found a problem that could be causing your pelvic pain, you will be treated for that problem. Some common treatments include:

Birth control pills or hormone treatment for problems related to your periods.
Surgery to remove a growth, cyst, or tumor.
Medicine to treat the problem, such as an antibiotic for infection or medicine for irritable bowel syndrome.
Chronic pain can become a medical problem in itself. Whether or not a cause is found, your doctor can suggest treatments to help you manage the pain. You may get the best results from a combination of treatments such as:

Pain relievers called NSAIDs, like ibuprofen (such as Advil or Motrin) or naproxen (such as Aleve). You can buy these over the counter, or your doctor may prescribe stronger ones. These medicines work best if you take them on a regular schedule, not just when you have pain. Your doctor can tell you how much to take and how often.
Tricyclic antidepressant medicine, which can help with pain as well as depression.
Cognitive-behavioral therapy or biofeedback, to help you change the way you think about or react to pain.
Counseling, to give you emotional support and reduce stress.
You may need to try many treatments before you find the ones that help you the most. If the things you're using aren't working well, ask your doctor what else you can try. Taking an active role in your treatment may help you feel more hopeful.