Chronic Pelvic Pain

Written By Brooke Hyman

Chronic Pelvic Pain

Today I want to talk about a condition that is both common and often overlooked: chronic pelvic pain. Despite affecting an estimated 10–20% of women in the United States, it remains under-recognized and under-treated.

What Is Chronic Pelvic Pain?

Chronic pelvic pain is defined as recurrent or constant pain in the lower abdomen or pelvic area lasting at least three to six months. Unlike occasional discomfort, this pain persists over time and can become deeply disruptive.

The Impact on Daily Life

The effects of chronic pelvic pain extend far beyond physical symptoms. It can limit a woman’s ability to work, care for her family, or participate fully in her relationships. Many women with chronic pelvic pain require frequent doctor visits, imaging studies, lab work, medications, and sometimes even surgeries, such as diagnostic laparoscopy or hysterectomy.

A recent study estimated that the healthcare costs for women with chronic pelvic pain averaged $12,254 per year—and that doesn’t include the hidden costs of missed work, reduced productivity, childcare arrangements, or transportation to medical visits. The burden is not just physical, but also emotional and financial.

This is why I care so deeply about treating chronic pelvic pain.

Why Treatment Can Be So Challenging

When I see women in my office for this issue, I am often not the first doctor they’ve consulted. Many patients have felt unheard and dismissed by the medical community, sometimes even questioning their own sanity.

The truth is, there’s no single answer for chronic pelvic pain. Unlike a condition with a clear-cut treatment, this pain often has multiple contributing factors. In medicine, we use a principle called Hickam’s Dictum: “Patients can have as many diseases as they damn well please.” In other words, chronic pain rarely stems from just one cause. By identifying all of the causes, we can address each one. We may not be able to get your pain to zero, but our goal is to improve your pain such that you can re-engage in your life. Together, we will manage your pain, rather than having your pain manage you. This will take time, and there may be flares along the way.

Possible Causes of Chronic Pelvic Pain

When I evaluate a patient, I take a thorough history and ask detailed questions about the onset, timing, triggers, and previous treatments. Chronic pelvic pain can come from many different systems in the body, including those listed below. Please note that this list is not comprehensive!

Gynecologic causes

  • Endometriosis

  • Adenomyosis

  • Dysmenorrhea (painful periods without structural cause)

  • Ovarian cysts or fibroids

  • Vulvodynia or vestibulodynia

  • Sexually transmitted infections

  • Pelvic congestion syndrome

  • Scar tissue from prior surgeries (including C-sections)

Musculoskeletal causes

  • Abdominal wall trigger points

  • Pelvic floor dysfunction (tight or weak muscles in the vaginal area)

  • Coccydynia (tailbone pain)

  • Pelvic tilt or sacroiliac joint pain

  • Low back pain from trauma or falls

Neurologic causes

  • Nerve pain (ilioinguinal, iliohypogastric, pudendal neuralgia, etc.)

  • Pain related to nerve entrapment in the pelvis or abdomen

Urologic causes

  • Urinary tract infections

  • Painful bladder syndrome / interstitial cystitis

Gastrointestinal causes

  • Irritable bowel syndrome (IBS)

  • Crohn’s disease

  • Chronic constipation

Psychological factors

  • Past trauma (sexual, emotional, or verbal abuse)

  • Anxiety or depression, which can worsen pain perception

A Path Forward

Treatment begins with identifying all the contributing factors—because usually, it’s more than one. From there, we build a comprehensive treatment plan tailored to each cause.

Patients often leave my office with “homework,” whether that’s physical therapy, dietary adjustments, or specialized treatments. But more importantly, they leave with answers—and the reassurance that their pain is real, valid, and treatable.

If you’re struggling with chronic pelvic pain, please know this:

  • You are not crazy.

  • This pain is not in your head.

  • There is hope, and treatment is possible.

You deserve to be heard, believed, and cared for with compassion. Chronic pelvic pain may be complex, but with the right approach, we can make a real difference in your quality of life.

Brooke Hyman