Symptoms and Causes of Pelvic Pain in Women

By Dr. Sonia

Pelvic pain affects one in every seven women, making it one of the most common women’s health issues in the world. From constipation and PMS to vulvodynia and pelvic inflammatory disease, there are many gynecological issues that can cause pelvic pain. When pelvic pain flares up, it can be difficult to tell if the cause is a simple condition you can manage at home or if it’s something more serious that requires a pelvic exam and treatment. Itching, burning, swelling, fatigue, urinary tract infections (UTIs), and painful intercourse: it’s not a pretty picture, but these are all common symptoms of pelvic pain. Even though pelvic pain is extremely common for both women and men, it can be challenging to fully understand the underlying causes without professional help. Fortunately, we have made breakthroughs in terms of symptom relief and we’re here to help. Ready to uncover what’s causing your pelvic pain? Let’s dive into the common causes of pelvic pain.

What Causes Pelvic Pain in Women?  

Pelvic pain refers to any pain in the lower abdomen and pelvic region, encompassing all the organs of your reproductive system and most of your digestive and urinary systems. There’s a lot happening in the pelvic area, stomach, bowel, bladder, uterus, ovaries, and more — so the source of pelvic pain can often be tough to identify. Just like there are many diverse symptoms of pelvic pain, there are many different things that could be causing it. Some conditions are more serious than others but most can be treated with various types of medications, in-office procedures, or in conjunction with pelvic floor therapy or psychotherapy (or a combination of all of these). 

If you’re experiencing pelvic pain, it could be caused by one of the following conditions: 

Vulvodynia or Vestibulodynia: These conditions are some of the most elusive causes of pelvic pain. Since they aren’t associated with any physical cause, it can be tricky to get to the root cause and patients may suffer for a long time before getting a proper diagnosis. Symptoms of vulvodynia/vestibulodynia include burning or feeling raw in or around the vagina, swelling or throbbing of the vulva, intense itching, and extreme pain during intercourse. A combination of therapies can lead to a pain-free life. “Vulvodynia” (or Vestibulodynia) is a condition that causes intense, chronic pelvic pain in the vulva can affect as much as 16% of women. Again, this number is likely largely underdiagnosed, particularly because it has been estimated that approximately 40-49% of women with chronic vulvar pain do not seek medical care for their pain, leaving estimates unreliable and likely dramatically underestimating the true prevalence. 

For some, the pain only occurs with contact or pressure, or what we call “provoked” pain. For others, it’s a constant, stabbing pain that interferes with every aspect of their life. Living with this condition can be so uncomfortable that it becomes impossible to sit for long periods of time or even think about having sex. Some people may even find it impossible to wear tampons. But Vulvodynia is not just a physical condition — it can cause emotional distress, depression, and feelings of hopelessness. Many women suffer from vulvodynia for years before finding a pelvic pain specialist with the knowledge and expertise to diagnose their condition. The key to finding relief is to first understand the nuances of vaginal pain in order to take a holistic approach to healing. 

Since there is no clear cause of this condition, diagnosing vulvodynia or vestibulodynia can be quite difficult, but –

Symptoms are similar to other pelvic pain conditions and may include: 

• Burning sensation in or around the vagina 
• Swelling of the vulva 
• Extreme pain during intercourse 
• Feeling raw in or around the vagina 
• Intense itching 
• Throbbing of the vulvar area 
• Clitoral pain 

For many patients, trying (and failing) to get this type of pelvic pain diagnosed is often the most challenging part of living with vulvodynia. Given the nature of the condition, it can take time for practitioners to understand the underlying cause and develop an appropriate treatment plan. However, if you’re experiencing this type of pain, there is no reason to lose hope. Treatment is absolutely possible.

Endometriosis: Endometriosis occurs when uterine cells grow outside the uterus, typically on the bladder, ovaries, or fallopian tubes. This can cause extremely painful and irregular periods, gastrointestinal discomfort, and pain during urination, bowel movements, and intercourse. If you don’t get this type of pelvic pain treated, endometriosis can cause infertility, so if you’re experiencing any of these symptoms, it’s important to speak with a pelvic pain specialist. Medications and hormonal therapy can relieve symptoms of pelvic and bladder pain, but surgery may be necessary in certain cases.

What is Endometriosis? 

Simply put, endometriosis is when tissue similar to the uterine lining is found outside the uterus in other parts of the body. This tissue goes through the usual process of thickening, breaking down, and shedding like uterine tissue normally would in the uterus. But when this process happens in other organs, it doesn’t have anywhere to go. So instead of shedding and exiting through your vagina during your period, this endometrial tissue becomes trapped. The presence of these cells where they don’t necessarily belong can ignite a potentially severe inflammatory response, leading to wide-ranging symptoms. In the United States, it’s thought that about 10% of the population can be affected, likely a drastic understatement due to the issues with an appropriate diagnosis.

Because endometriosis is tissue that is similar to uterine cells but not exactly, this health issue can occur when a uterus isn’t present in the body. Endometriosis can happen to those without a uterus, to those who don’t have periods, and it is not exclusive to women; although extremely rare, it can also occur in men. 

First Signs of Endometriosis Presentation –

An unusually painful period is not the only symptom of endometriosis. Some don’t experience this tell-tale sign at all. And at times, the level of pain depends on where the uterine-like tissue is growing and how much. So, with that in mind, consider if you have these other early symptoms of endometriosis: 

• Pain when urinating or having a bowel movement 
• Blood in your urine or stools 
• Pain during or after sex 
• Excessive bleeding during your period 
• Excessive bleeding between your periods 
• Back pain during your period 
• Gastrointestinal issues like diarrhea, constipation, nausea, or bloating 
• Nausea or vomiting 
• Difficulty getting pregnant 
• Fatigue 

Pelvic Floor Dysfunction: Pelvic floor dysfunction refers to a lack of control over the pelvic floor muscles. When you have proper pelvic floor function, these muscles assist in normal bodily functions, such as urination and bowel movements. If they become too weak or too tight, they can cause a variety of pelvic issues, including pain, incontinence, constipation, and sexual dysfunction.  

The pelvic floor isn’t a part of the body most people often think about — if they even know what it is at all. But your pelvic floor muscles are involved in many of your body’s day-to-day functions. When you have proper pelvic floor function, these muscles assist in urination and bowel movements, allowing you to have conscious control of your bladder and bowel. They also provide support for your pelvic organs, which includes the bowel and bladder for men, and the bowel, bladder, and uterus for women. The pelvic floor muscles play an important role in sexual health, too. In men, the pelvic floor allows men to achieve an erection and ejaculation, while for women, voluntary contraction of the pelvic floor muscles can increase sensation. During pregnancy, the pelvic floor muscles also provide support to the baby.  

But, if you don’t have control over your pelvic floor, it can lead to a host of issues and discomfort. Since the pelvic floor muscles need to be contracted and relaxed to perform various functions, improper function can cause incontinence, severe constipation, pain during sex, and more. Fortunately, with pelvic floor physical therapy, you can regain control of your pelvic floor and get your life back. 

What is Pelvic Floor Dysfunction? 

Your pelvic floor muscles are the muscles you use to do Kegel exercises or to stop the flow of urine. When relaxed, they allow for normal urination and bowel movements — but if they’re too relaxed, you may experience incontinence. When taut, they support your internal organs — but if they get too tight, they can cause pelvic pain and gastrointestinal symptoms, such as chronic constipation. In fact, they can get so wound up that even inserting a tampon becomes impossible.

Symptoms of hypertonic pelvic floor muscle dysfunction may include: 

• Sensations of burning, rawness, throbbing, stabbing, or aching in the vagina 
• Urinary symptoms such as frequency, urgency, and incomplete emptying of the bladder 
• Pain during intercourse or inability to have penetrative sex 
• Hemorrhoids or rectal fissures (tears in the anal area) 
• Low back and/or hip pain 
• Constipation 

There is no one clear cause of pelvic floor dysfunction. Contributing factors for hypertonic pelvic floor dysfunction may include anxiety, stress, hip or low back injury, holding urine, excessive core-strengthening exercises, or physical or psychological trauma. Childbirth, straining during bowel movements, high-intensity exercise, obesity, and age may contribute to a weakened pelvic floor. 

Interstitial Cystitis: Also known as bladder pain syndrome, interstitial cystitis is characterized by a chronically inflamed bladder.

The exact cause of interstitial cystitis continues to be studied, but a multifactorial approach (including medications; various procedures, such as bladder instillations, cystoscopy, and/or certain interventions; and changes to diet and lifestyle) can help to alleviate symptoms. 

Do I Have Interstitial Cystitis/Bladder Pain Syndrome? 

The symptoms of bladder pain syndrome, or interstitial cystitis, are very similar to those of a urinary tract infection: bladder pain accompanied by frequent, urgent, and painful urination.  

Symptoms and severity vary from person to person, but most people with interstitial cystitis will also experience some combination of the following symptoms: 

• Pressure in the abdomen/bladder 
• Pain in the abdomen/bladder 
• Prolonged lower urinary tract symptoms with no infection 
• Pain during urination 
• Pain during sex 
• Frequency and urgency of urination 
• Difficulty starting/completing a stream 
• Pushing or straining to start stream 
• Pain with bladder filling 

The most important thing to know about bladder pain syndrome is that even though they share many of the same symptoms, a urinary tract infection and bladder pain syndrome are not the same conditions. Their causes are completely different, as are the methods to treat them. 

Pelvic Inflammatory Disease: The result of untreated sexually transmitted infections, pelvic inflammatory disease can cause exaggerated symptoms of STIs. Heavy vaginal discharge with an odor, pelvic tenderness, fatigue, and pain or bleeding during sex are all common symptoms of pelvic inflammatory disease. You can avoid pelvic inflammatory disease by practicing safe sex and proper hygiene practices. Treatment for pelvic inflammatory disease includes antibiotics.  

Uterine Fibroids: Pelvic pain can also be caused by non-cancerous lesions in or on the uterus, known as fibroids. While some women won’t experience any symptoms of uterine fibroids, others will feel pressure in the abdomen, heavy or prolonged menstrual bleeding, constipation, and leg or back pain. In most cases, uterine fibroids don’t interfere with the quality of life and intervention isn’t necessary. However, if fibroids are causing pelvic pain, hormonal therapy or surgery can help you find relief. 

The cause of pelvic pain ranges the entire spectrum. Symptoms often overlap making accurate diagnosis and treatment sometimes difficult. Remember that if you are experiencing any or all of these symptoms they are real —and help is within your reach. 

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Dr. Sonia

ASTROGLIDE’S SEXUAL HEALTH ADVISOR

Sonia Bahlani, MD, is a pelvic pain specialist who takes a holistic view of common women’s health issues. After completing her OB/GYN residency, she pursued a fellowship in urology, working with pioneers in the world of pelvic pain. Having trained in these two areas gives her a unique perspective in her approach to women's health. She takes a compassionate, patient-centric approach and listens to her patients to gain a deep understanding of their challenges.