What is Chronic Pelvic Pain?
Chronic pelvic pain (CPP) is persistent or recurrent pain in the lower abdomen or pelvis, often lasting six months or longer. It can significantly affect sleep, mobility, work, relationships, sexual health, and emotional wellbeing.
Causes
CPP is often multifactorial, with more than one contributing factor. Common gynecologic causes include:
- Endometriosis — one of the most frequently identified causes
- Adenomyosis — endometrial tissue within the uterine muscle wall
- Pelvic adhesions — scar tissue from prior surgery or infection
- Ovarian cysts — persistent or recurrent cysts
- Pelvic inflammatory disease — chronic effects of prior pelvic infection
- Uterine fibroids — in some cases
Non-Gynecologic Causes
- Bladder pain syndrome / interstitial cystitis
- Irritable bowel syndrome
- Musculoskeletal pain — including pelvic floor muscle dysfunction
- Pudendal neuralgia — nerve-related pain
- Nervous-system and emotional health factors — sleep, stress, anxiety, trauma, and depression can influence pain intensity and coping, but the pain is real and is not assumed to be psychological
Evaluation
A thorough, systematic evaluation is essential:
- Detailed history: Characterizing pain location, timing, triggers, severity, and associated symptoms
- Physical examination: Including abdominal, pelvic, and pelvic floor muscle assessment
- Imaging: Pelvic ultrasound and potentially MRI
- Directed laboratory tests: As indicated by clinical findings
- Diagnostic laparoscopy: Considered selectively when non-invasive evaluation is inconclusive, a surgically treatable condition is suspected, and the result is expected to change management
Management Approach
Management requires an individualized, multimodal approach:
Medical Management
- Hormonal therapies for endometriosis or adenomyosis-related pain
- Analgesics tailored to pain type and severity
- Neuromodulating agents for neuropathic pain components
Pelvic Floor Physiotherapy
Pelvic floor muscle dysfunction is a common and often underrecognized contributor to CPP. Specialized physiotherapy focusing on muscle relaxation, myofascial release, and neuromuscular retraining can significantly improve symptoms.
Surgical Management
- Laparoscopy for selected cases of suspected endometriosis or other surgically treatable pathology
- Excision of endometriosis
- Adhesiolysis only in selected circumstances; dividing mild adhesions has not consistently been shown to improve chronic pain
- Hysterectomy in carefully selected cases when symptoms appear uterine in origin and childbearing is complete; it does not guarantee pain relief when pain has several contributors
Multidisciplinary Care
Optimal management often involves collaboration between gynecology, pain medicine, gastroenterology, urology, physiotherapy, and psychological support services.
Outlook
CPP can often be improved, but recovery is rarely tied to a single test or treatment. The goal is better function and quality of life through a plan tailored to each patient's contributors, priorities, and response over time.
Sources
Clinical content updated July 2026. Source: ACOG: Chronic Pelvic Pain.