Between your reproductive organs and your digestive organs, there’s a lot going on in the area from your navel to your vulva, so it can be hard to pinpoint the cause of pelvic pain. That’s why, even though research suggests 20% of American women between ages 30 and 64 have experienced pain in their pelvic region, it can be difficult to find pain relief.
Endometriosis is a prime example: An estimated 10% of women of child-bearing age suffer from the painful condition yet it takes an average of 8 to 12 years to receive that diagnosis, according to research. Like some other problems that occur in the pelvis, endometriosis doesn’t have a simple diagnostic test to confirm what’s going on so doctors have to know what clues to look for.
Fortunately, the list below should help you: The conditions here are some of the most common causes of pelvic pain among women. If you’re feeling uncomfortable and think something mentioned below could be the reason for your suffering, make an appointment with your gynecologist and let them know what’s going on. If they dismiss you or aren’t hell-bent on finding the root of your pain, get a second opinion.
If you experience a burning sensation when you pee and feel the urge to urinate often, you probably have a urinary tract infection (UTI) in your bladder. Women are prone to UTIs because our urethra is much shorter than men’s so it’s easier for infection-causing bacteria to get in and wreak havoc, says Karyn S. Eilber, M.D., a board-certified urologist with a subspecialty in female pelvic medicine and reconstructive surgery at Cedars Sinai. Antibiotics usually kill off the bacteria effectively, but if pain worsens or you have a fever or nausea, see a doctor ASAP because the infection may have spread to your kidneys.
Pelvic pressure and painful periods are common symptoms of fibroids. Many women develop these noncancerous growths in their uterus, which can inflict pain when they put pressure on nearby organs or start to degenerate. “A degenerating fibroid is one that has outgrown its blood supply,” explains Kiarra King, M.D., a board certified obstetrician/gynecologist in Chicago. Without adequate blood supply, the tissue dies and can lead to pain, she says. On top of discomfort, fibroids can cause constipation, urination problems and heavy or long-lasting periods. The location, size and number of them will affect your symptoms as well as the treatment your doctor advises, such as meds or surgical procedures.
If you are sidelined by severe cramping deep in your abdomen, endometriosis is a possibility. The condition occurs when tissue that is similar to the uterine lining grows outside of it, explains Iris Kerin Orbuch, M.D., a fellowship-trained endometriosis excision surgeon and co-author of Beating Endo. The pain can flare at any time of the month and because endometrial-like tissue can attach to any organ, symptoms may range from GI issues and heavy periods to back pain and fatigue. Treatment often includes medications or surgery.
Interstitial cystitis occurs when the bladder’s lining is irritated — so you might feel the urge to pee but little urine comes out. You might also experience pain or pressure in your bladder. Unlike with a UTI, this condition tends to be chronic rather than acute. No single treatment works for everyone, but your best bet is to see a urologist or urogynecologist who can explain the options.
Pelvic inflammatory disease
If you have discomfort and unusual discharge, you could have pelvic inflammatory disease (PID). “If bacteria gains access to the inside of the uterus, the fallopian tubes or the ovaries, that can lead to a pelvic inflammatory disease,” says Dr. King, “which can present with pelvic pain, discomfort, discharge, cramping and a positive STD screen although it is possible to have PID due to bacteria that are not related to a sexually transmitted infection.” Your doctor will likely prescribe antibiotics to prevent the infection from spreading.
Sharp pain on one side could indicate an ovarian cyst. When fluid collects on or within an ovary, it can form a cyst and if a cyst becomes large or it ruptures that can be painful. “It may get worse when you lay flat,” says Sherry Ross, M.D., an obstetrician/gynecologist and author of She-ology. Once imaging shows that it’s a cyst, your doc may suggest a “watch and wait” approach or surgical removal. “The characteristics of the cysts, the age of the person and the symptoms will determine the best course of action,” says Dr. King. If you have recurrent cysts that form after ovulation, they may prescribe hormonal contraceptives, she adds.
Pelvic pain is any type of discomfort that’s felt in your lower abdomen. It could be sharp, dull, acute, chronic or anything in between. Your bladder, colon and rectum all sit in your pelvic cavity — in addition to reproductive organs and various muscles, Dr. King points out. That means the pain could caused by a lot of things, and some can’t be seen on imaging or in lab work. That’s why “patients have to be their best advocates when it comes to pelvic pain,” says Dr. Ross. In addition to the conditions listed above, here are more causes of pelvic pain in women:
- Ectopic pregnancy (when a fertilized egg grows outside the uterus)
- Low vaginal estrogen (which is often caused by menopause or hormonal contraceptives)
- Menstruation (pain may come in the form of muscle cramps right before and during one’s period)
- Miscarriage (loss of a pregnancy)
- Pelvic congestion syndrome (pain thought to be caused by enlarged veins in the pelvic area)
- Pelvic organ prolapse (when one or more organs slips out of place and causes a bulge in the vagina)
- Sexually transmitted infections (STIs)
- Uterine or cervical cancer (tumors that begin in the endometrium or cervix)
- Vaginismus (involuntary spasms of the vagina)
- Vulvodynia (pain in the vulva)
How is pelvic pain diagnosed?
After you describe your pain to your gynecologist, they will perform a physical pelvic exam. Include as much information as possible in your description, such as where you feel the pain, what exactly it feels like, and whether it’s constant or comes and goes with certain activities. Depending on your symptoms, your doctor may perform a Pap test, collect a urine or blood sample and/or recommend an ultrasound or other imaging. Sometimes, like in the case of endometriosis, the only way to confirm the condition is with laparoscopic surgery. If all of your reproductive organs seem to check out and you’re still in pain, ask for a referral to a gastroenterologist, urologist or other specialist, suggests Dr. King. Here are some other causes of pelvic pain that are not related to women’s reproductive organs:
- Appendicitis
- Broken pelvis
- Fibromyalgia
- Gastrointestinal problems (such as IBS, IBD, SIBO or diverticulitis)
- Hernia
- Kidney infection or stones
- Nerve conditions
- Pelvis disorder
- Prostate or testicular problems
- Psychogenic pain
- Scar tissue
- Urinary stones
How is pelvic pain treated?
It depends on what’s causing your pain. Potential treatments include medications, lifestyle changes, pelvic floor physical therapy and surgery. Some conditions can be easily resolved with one treatment while others are more complicated and require a multi-pronged approach.
When should you see a doctor for pelvic pain?
If you’re in pain and it’s not going away or it’s disrupting your daily life, schedule an appointment with a physician, says Dr. Orbuch. If that doctor doesn’t take you seriously, get a second opinion. “Women should never minimize any pelvic pain they’re experiencing,” says Dr. Ross. That includes pain during sex, which research shows is pretty common. While many things can cause painful intercourse (formally called dyspareunia), including vaginismus and low vaginal estrogen, there’s usually a remedy for those problems, says Dr. King. People are often ashamed to admit when they find sex painful, she says, “but that’s part of people’s health and well-being.” If you have pain, get checked out.
Kaitlyn Pirie
Senior Editor
For over ten years, Kaitlyn Pirie has interviewed top health experts and pored over studies to figure out how our bodies work, turning her research into easy-to-read stories about medical conditions, nutrition, fitness and mental health.
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