Pelvic pain is discomfort that occurs in the lowest part of the abdomen. Pain that occurs externally in the genital area (vulva, or labia) is called vulvar pain. Many women have pelvic pain. Pain is considered chronic if it continues to occur for more than 3 to 6 months.
Pelvic pain can be a gynecologic symptom. That is, it can result from a problem affecting the female reproductive system. Or it may be caused by problems in the urinary, digestive, or musculoskeletal system.
The pain may start suddenly or gradually. The pain may gradually increase in intensity, sometimes occurring in waves. It may be constant or come and go. It may be sharp or dull or crampy (like menstrual cramps), or some combination.
The pelvic area may feel tender if touched. Depending on the cause, women may have bleeding Vaginal Bleeding Abnormal vaginal bleeding includes any vaginal bleeding that occurs Before puberty Between menstrual periods During pregnancy After menopause (12 months or more after the last menstrual period) read more or a discharge Vaginal Discharge A discharge from the vagina may occur normally or may result from inflammation of the vagina (vaginitis), often due to an infection. The genital area (vulva)—the area around the opening of the... read more from the vagina. The pain may also be accompanied by fever, nausea, vomiting, and/or light-headedness.
Causes of Pelvic Pain
Pelvic pain is often related to the menstrual cycle Menstrual Cycle Menstruation is the shedding of the lining of the uterus (endometrium) accompanied by bleeding. It occurs in approximately monthly cycles throughout a woman's reproductive life, except during... read more or common gynecologic issues. However, several disorders that cause pelvic pain can lead to peritonitis Peritonitis Abdominal pain is common and often minor. Severe abdominal pain that comes on quickly, however, almost always indicates a significant problem. The pain may be the only sign of the need for surgery... read more (inflammation and usually infection of the abdominal cavity), which is a serious disorder.
Disorders that can cause pelvic pain include
Gynecologic disorders—those that affect the reproductive organs (vagina, cervix, uterus, fallopian tubes, and ovaries)
Disorders that affect other organs in the pelvis, such as the bladder, lower part of the ureters, urethra, rectum, appendix, or pelvic floor (the muscles, ligaments, and tissues that support the organs of the pelvis)
Disorders that affect structures near but outside the pelvis, such as the abdominal wall, intestine, kidneys, or upper part of the ureters
Often, it is difficult for doctors to identify what is causing pelvic pain.
Gynecologic disorders may be related to the menstrual cycle or not.
Overall, the most common gynecologic causes of pelvic pain include
Endometriosis Endometriosis In endometriosis, patches of endometrial tissue—normally occurring only in the lining of the uterus (endometrium)—appear outside the uterus. Why endometrial tissue appears outside the uterus... read more (abnormally located patches of tissue that is normally located only in the lining of the uterus)
Fibroids Fibroids A fibroid is a noncancerous tumor composed of muscle and fibrous tissue. It is located in the uterus. Fibroids can cause pain, abnormal vaginal bleeding, constipation, repeated miscarriages... read more in the uterus are noncancerous tumors composed of muscle and fibrous tissue. They can cause pelvic pain if they put pressure on other organs, are degenerating, or cause excessive bleeding or cramping. Most uterine fibroids do not cause pain.
Many other gynecologic disorders can cause pelvic pain (see table Some Gynecologic Causes of Pelvic Pain Some Causes of Pelvic Pain in Women* ).
Other causes of pelvic pain include
Digestive tract disorders: Gastroenteritis Overview of Gastroenteritis Gastroenteritis is inflammation of the lining of the stomach and small and large intestines. It is usually caused by infection with a microorganism but can also be caused by ingestion of chemical... read more , constipation Constipation in Adults Constipation is difficult or infrequent bowel movements, hard stool, or a feeling that the rectum is not totally empty after a bowel movement (incomplete evacuation). (See also Constipation... read more , diverticulitis Diverticulitis Diverticulitis is inflammation of one or more balloon-like sacs (diverticula). Infection may or may not develop. Diverticulitis usually affects the large intestine (colon). Left lower abdominal... read more , irritable bowel syndrome Irritable Bowel Syndrome (IBS) Irritable bowel syndrome is a disorder of the digestive tract that causes recurring abdominal pain and constipation or diarrhea. Symptoms vary but often include lower abdominal pain, bloating... read more , inflammatory bowel disease Overview of Inflammatory Bowel Disease (IBD) In inflammatory bowel diseases, the intestine (bowel) becomes inflamed, often causing recurring abdominal pain and diarrhea. The two primary types of inflammatory bowel disease (IBD) are Crohn... read more , collections of pus (abscesses), and tumors (cancerous or not), such as colon cancer Colorectal Cancer Family history and some dietary factors (low fiber, high fat) increase a person’s risk of colorectal cancer. Typical symptoms include bleeding during a bowel movement, fatigue, and weakness... read more
Urinary disorders: Urinary tract infections Bladder Infection Cystitis is infection of the bladder. Usually, bacteria are the cause of cystitis. A frequent need to urinate and pain or burning while urinating are the most common symptoms. Doctors can often... read more , kidney stones Stones in the Urinary Tract Stones (calculi) are hard masses that form in the urinary tract and may cause pain, bleeding, or an infection or block of the flow of urine. Tiny stones may cause no symptoms, but larger stones... read more that have passed into the lower urinary tract, and inflammation of the bladder without infection (such as interstitial cystitis Interstitial Cystitis Interstitial cystitis is noninfectious bladder inflammation. Interstitial cystitis causes pain above the bladder, in the pelvis, or in the lower abdomen, and the frequent and urgent need to... read more )
Musculoskeletal disorders: Fibromyalgia Fibromyalgia Fibromyalgia is characterized by poor sleep, fatigue, mental cloudiness, and widespread aching and stiffness in soft tissues, including muscles, tendons, and ligaments. Poor sleep, stress, strains... read more or chronic myofascial pain (pain that is caused by tension and tenderness in areas of muscle called trigger points)
Psychologic factors, especially stress and depression Depression A short discussion of prolonged grief disorder. Depression is a feeling of sadness and/or a decreased interest or pleasure in activities that becomes a disorder when it is intense enough to... read more , may contribute to any kind of pain, including pelvic pain, but, by themselves, rarely cause pelvic pain. Women or girls that have had sexual trauma may develop chronic pelvic pain.
Evaluation of Pelvic Pain
Usually, pelvic pain is not an emergency, but when a woman has new, sudden, very severe pain in the lower abdomen or pelvis, medical attention should be sought as soon as possible. Sometimes, emergency surgery is required. Disorders that usually require emergency surgery include
A ruptured ectopic pregnancy Ectopic Pregnancy Ectopic pregnancy is attachment (implantation) of a fertilized egg in an abnormal location, such as the fallopian tubes. In an ectopic pregnancy, the fetus cannot survive. When an ectopic pregnancy... read more (an abnormally located pregnancy—not in its usual place in the uterus)
A ruptured abscess in the pelvis
A tear in the intestine
Doctors check for pregnancy in all girls and women of childbearing age.
In women with pelvic pain, certain symptoms are cause for concern:
Light-headedness or sudden loss of consciousness (fainting, or syncope), however brief
Sudden, severe pain, especially when accompanied by nausea, vomiting, excessive sweating, or agitation
Fever or chills
Vaginal bleeding after menopause
When to see a doctor
Women with most warning signs should see a doctor immediately.
Women may need to be seen the same day or within a few days if they have
Vaginal bleeding after menopause
Pain that is constant or steadily worsening
If women have new pain that is not constant and is not worsening or if they have pain that is recurring or chronic, they should schedule a visit when practical, but a delay of several days is usually not harmful.
Mild menstrual cramps are normal. Menstrual cramps do not require evaluation unless they are very painful.
What the doctor does
The doctor does a quick evaluation to see if emergency treatment is needed. Doctors ask the woman questions about her symptoms and medical history. Doctors then do a physical examination. What they find during the history and physical examination often suggests a cause and the tests that may need to be done (see table Some Gynecologic Causes of Pelvic Pain Some Causes of Pelvic Pain in Women* ).
Doctors ask about the pain:
Whether it begins suddenly or gradually
Whether it is sharp or dull
How severe it is
When it occurs in relation to the menstrual cycle, eating, sleeping, sexual intercourse, physical activity, urination, and bowel movements
Whether any other factors worsen or ease the pain
The woman is asked about other symptoms, such as vaginal bleeding, a discharge, and light-headedness.
The woman is asked to describe past pregnancies and menstrual periods. Doctors also ask whether she has had any disorders that can cause pelvic pain and whether she has had abdominal or pelvic surgery.
Doctors may ask about stress, depression, and other psychologic factors to determine whether these factors may be contributing to the pain, especially if the pain is chronic.
Certain groups of symptoms that accompany pelvic pain suggest a type of medical condition. For example,
Fever and chills suggest an infection.
A vaginal discharge suggests an infection, such as pelvic inflammatory disease Pelvic Inflammatory Disease (PID) Pelvic inflammatory disease is an infection of the upper female reproductive organs (the cervix, uterus, fallopian tubes, and ovaries). Pelvic inflammatory disease is often caused by a sexually... read more .
Abdominal pain, a change in bowel movements, or rectal bleeding suggests a digestive tract disorder.
Vaginal bleeding during pregnancy suggests an ectopic pregnancy Ectopic Pregnancy Ectopic pregnancy is attachment (implantation) of a fertilized egg in an abnormal location, such as the fallopian tubes. In an ectopic pregnancy, the fetus cannot survive. When an ectopic pregnancy... read more or a possible miscarriage Miscarriage A miscarriage is the loss of a fetus before 20 weeks of pregnancy. Miscarriages may occur because of a problem in the fetus (such as a genetic disorder or birth defect) or in the woman (such... read more .
The physical examination starts with checking vital signs, such as temperature, blood pressure, and pulse. Then doctors focus on the abdomen and pelvis. Doctors gently feel the abdomen and do a pelvic examination Gynecologic Examination For gynecologic care, a woman should choose a health care practitioner with whom she can comfortably discuss sensitive topics, such as sex, birth control, pregnancy, and problems related to... read more . During an examination, the abdomen or other areas may feel tender if touched. This evaluation helps doctors determine which organs are affected and whether an infection is present. Often, doctors also check the rectum for abnormalities.
The following tests are routinely done:
A pregnancy test if women are of childbearing age
Urinalysis Urinalysis and Urine Culture Urinalysis, the testing of urine, may be necessary in the evaluation of kidney and urinary tract disorders and can also help evaluate bodywide disorders such as diabetes or liver problems. A... read more is a simple, fast urine test that is a first step to check for many common causes of pelvic disorders such as a bladder infection or most kidney stones. A urine culture is done if a urinary tract infection Bladder Infection Cystitis is infection of the bladder. Usually, bacteria are the cause of cystitis. A frequent need to urinate and pain or burning while urinating are the most common symptoms. Doctors can often... read more is suspected.
A pregnancy test is done if a woman is in her reproductive years. A urine pregnancy test is usually done first. If a very early pregnancy is possible and the urine test is negative, a blood test for pregnancy is done. The blood test is more accurate than the urine test when a pregnancy is less than 5 weeks.
If a woman is pregnant and has pain or vaginal bleeding, ultrasonography is done to rule out an ectopic pregnancy Ectopic Pregnancy Ectopic pregnancy is attachment (implantation) of a fertilized egg in an abnormal location, such as the fallopian tubes. In an ectopic pregnancy, the fetus cannot survive. When an ectopic pregnancy... read more . For ultrasonography, doctors use a handheld ultrasound device that is placed on the abdomen or inside the vagina. Ultrasonography of the pelvis is done for many reasons. It is done whenever doctors think a gynecologic disorder may be the cause of the symptoms and the symptoms have begun suddenly, recur, or are severe.
If results of ultrasonography are unclear, other tests, such as a series of blood tests or laparoscopy, are done to rule out ectopic pregnancy. For the blood tests, doctors measure levels of a hormone produced by the placenta called human chorionic gonadotropin (hCG). If hCG levels are low, the pregnancy may be too early for ultrasonography to detect. If levels are high and ultrasonography does not detect a pregnancy, ectopic pregnancy is possible. For laparoscopy, doctors make a small incision just below the navel and insert a viewing tube (laparoscope) to directly look for an ectopic pregnancy or other causes of pelvic pain.
Tests depend on which disorders are suspected. Tests may include
Urine tests or testing of samples from the vagina or cervix to check for infections that can cause pelvic pain
Ultrasonography, computed tomography (CT), or magnetic resonance imaging (MRI) of the abdomen and pelvis to check for masses Introduction to Miscellaneous Gynecologic Abnormalities Noncancerous (benign) gynecologic growths include cysts, polyps, and fibroids ( leiomyomas). Noncancerous growths can develop on the vulva or in the vagina, uterus, or ovaries. The vulva consists... read more and tumors
If other tests do not identify the cause of severe or persistent pain and a serious cause (such as a ruptured ectopic pregnancy) is suspected, sometimes laparoscopy or laparotomy
Treatment of Pelvic Pain
If the cause of the pelvic pain is identified, it is treated if possible. Pain related to the menstrual cycle (such as cramps or endometriosis) may be treated with hormonal contraceptives Hormonal Methods of Contraception Contraceptive hormones can be Taken by mouth (oral contraceptives) Inserted into the vagina (vaginal rings) Applied to the skin (patch) Implanted under the skin read more .
Pain relievers may also be needed. Initially, pain is treated with nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen. Women who do not respond well to one NSAID may respond to another. If NSAIDs are ineffective, other pain relievers or hypnosis may be tried.
If the pain involves muscles, rest, heat, or physical therapy may help.
Rarely, when women have severe pain that persists despite treatment, surgery, such as laparoscopy to treat endometriosis or an ovarian cyst or hysterectomy (surgery to remove the uterus), can be done.
Essentials for Older Women: Pelvic Pain
In older women, common causes of pelvic pain may be different because some disorders that cause pelvic pain or discomfort become more common as women age, particularly after menopause. Obviously, disorders related to menstrual periods are no longer possible causes.
Common disorders in older women include
Cancers of the reproductive tract Overview of Female Reproductive System Cancers Cancers can occur in any part of the female reproductive system—the vulva, vagina, cervix, uterus, fallopian tubes, or ovaries. These cancers are called gynecologic cancers. The most common... read more , including cancers of the lining of the uterus (endometrial cancer), ovaries, and vulva (labia)
After menopause, estrogen levels decrease, weakening many tissues, including bone, muscles (such as those supporting the bladder), and tissues around the vagina and urethra. As a result, pelvic fractures and bladder infections become more common.
Also, this weakening may contribute to pelvic organ prolapse, which may cause symptoms as women become older. In these disorders, weakened or damaged tissues in the pelvis can no longer hold the uterus, vagina, or other organs in the pelvis in place. As a result, one or more of these organs may drop down (prolapse) and women may feel pressure in the vagina or have urinary incontinence or difficulty having a bowel movement.
Symptoms that affect the vagina and urinary tract after menopause are called the genitourinary syndrome of menopause (formerly called vaginal atrophy or atrophic vaginitis). These symptoms include vaginal dryness, pain during sexual intercourse, urinary urgency, and urinary tract infections. This condition may make sexual intercourse painful, and women may describe or experience this pain as pelvic pain.
Evaluation is similar to that for younger women, except doctors pay particular attention to symptoms of urinary and digestive tract disorders that are common in older women. Older women should see a doctor promptly if they
Suddenly lose weight or their appetite
Suddenly start having indigestion
Have a sudden change in bowel movements
The doctor then does an examination to make sure that the cause is not ovarian or endometrial cancer.
If the vaginal lining is thin in a woman with pelvic pain, doctors ask her questions to determine whether she is sexually active. If so, doctors may recommend a break from sexual intercourse until symptoms subside, or they may prescribe an estrogen cream Forms of hormonal therapy .
Many women have pelvic pain.
Many disorders (related to reproductive organs or other nearby organs) can cause pelvic pain.
Doctors can determine likely causes based on a description of the pain, its relationship to the menstrual cycle, and results of a physical examination.
If women are of childbearing age, a pregnancy test is always done.
Urine tests and usually other tests, such as blood tests and ultrasonography of the pelvis, are done to confirm the suspected diagnosis.