Pelvic pain is a common problem in people assigned female at birth. The cause is often not clear. It can have many causes. In some cases, no disease can be found. Pelvic pain can be either acute or chronic. Acute means the pain is sudden and severe. Chronic means the pain either comes and goes or lasts for months or longer. Pelvic pain that lasts longer than 6 months and doesn't improve with treatment is known as chronic pelvic pain. Pelvic pain may start in reproductive, gastrointestinal, or muscular structures in and around the pelvis. In some cases, the pain may be influenced by psychological effects. This can make pain feel worse or cause pain where a clear physical problem is not found.

Pelvic pain can have many causes, such as:

• Inflammation or irritation of nerves caused by injury, fibrosis, pressure, or peritonitis.
• Muscle cramps.
• A pregnancy that happens outside the uterus (ectopic pregnancy).
• Pelvic inflammatory disease (PID), an infection of the reproductive organs.
• A twisted or ruptured ovarian cyst
• Miscarriage or threatened miscarriage.
• A urinary tract infection.
• Appendicitis.
• A ruptured fallopian tube.

Some of the conditions that can lead to chronic pelvic pain may include:

• Menstrual cramps.
• Endometriosis.
• Uterine fibroids (growths on or in the uterine wall).
• Scar tissue between the organs in the pelvic cavity.
• Endometrial polyps.
• Cancers of the reproductive tract.
• Other problems in the digestive, urinary, or nervous systems.
• Myofascial pain.

These are examples of the different types of pelvic pain most commonly described, and their possible cause or origin. Always talk with your doctor for a diagnosis.

Tests will be done to find the cause of the pelvic pain. Your doctor may ask you questions about the pain, such as:

• When and where does the pain happen?
• How long does the pain last?
• Is the pain related to your menstrual cycle, urination, or sexual activity?
• What does the pain feel like? For example, is it sharp or dull?
• What was happening when the pain started?
• How suddenly did the pain start?

Tell your doctor all you can about the timing of the pain and other symptoms related to eating, sleeping, sexual activity, and movement. This can help with a diagnosis.

The doctor will give you a physical and pelvic exam. You may have tests, such as:

• Blood tests.
• A pregnancy test.
• Urinalysis.
• A culture of cells from the cervix.

You may also have tests, such as:

• Ultrasound. This test uses high-frequency sound waves to create an image of organs.
• CT scan. This is an imaging test that uses X-rays and a computer to make detailed images of the body. A CT scan shows details of the bones, muscles, fat, and organs, and any abnormalities that may not show up on an ordinary X-ray.
• MRI. A noninvasive procedure that shows a 2-D view of an internal organ or structure.
• Laparoscopy. A minor surgical procedure in which a laparoscope, a thin tube with a lens and a light, is inserted into an incision in the abdominal wall. Using the laparoscope to see into the pelvic area, the doctor can determine the locations, extent, and size of any abnormalities such as endometrial growths.
• X-ray. A small amount of radiation is used to show images of bones and internal organs onto film.
• Colonoscopy. In this test, the doctor can view the entire length of the large intestine. It can often help find growths, inflamed tissue, ulcers, and bleeding. It is done by putting a long, flexible, lighted tube (colonoscope) in the rectum and up into the colon. The colonoscope lets the doctor see the lining of the colon, remove tissue to test, and treat some problems that are found.
• Sigmoidoscopy. This test lets the doctor examine the inside of a part of the large intestine. It can find the causes of diarrhea, abdominal pain, constipation, abnormal growths, and bleeding. A short, flexible, lighted tube (sigmoidoscope) is put into the rectum. The scope blows air into the intestine to inflate it and make viewing the inside easier.

Treatment may include:

• Antibiotics.
• Anti-inflammatory medicines.
• Pain medicines.
• Muscle relaxants.
• Relaxation exercises.
• Birth control pills.
• Surgery.
• Physical therapy.
• Trigger point injections.
• Botox.
• Neuromodulators.

If a physical cause can't be found, your doctor may refer you for counseling. This can help you use additional techniques to manage chronic pain. In other cases, you may benefit from:

• Nutrition changes.
• Environmental changes.
• Physical therapy.
• Pain management.

• Pelvic pain is a common problem in people assigned female at birth. Its cause is often unclear.
• Pain can be acute or chronic.
• Treatment will depend on the cause, as found by the physical exam and tests.
• Treatment may include medicines, surgery, physical therapy, or pain management.

Tips to help you get the most from a visit to your doctor:

• Know the reason for your visit and what you want to happen.
• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your doctor tells you.
• At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new directions your doctor gives you.
• Know why a new medicine or treatment is prescribed and how it will help you. Also know what the side effects are and when they should be reported.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if you do not take the medicine or have the test or procedure.
• If you have a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your doctor if you have questions, especially after office hours or on weekends and holidays.