If you’re one of the estimated 25 million women dealing with pain “down there,” embarrassment may be keeping you from getting the help you need. You’re not alone. Only an estimated 15% of women dealing with pelvic pain bring it up with their doctor.
Too many women assume pelvic pain – pain that mostly or only occurs in the area below a woman’s belly button – is something that “comes with the territory” and silently live with it. But there’s good news: You don’t have to.
What is Pelvic Pain?
Pain is the body’s way of letting you know something’s not right. While it’s common for many women to experience mild cramping or discomfort before or during their monthly menstrual cycle, pelvic pain can involve much more, including pain in your lower stomach or back, buttocks and genital area.
Pelvic pain may:
- Be steady or come and go
- Cause pressure or discomfort around the vaginal area
- Feel sharp and stabbing in a specific spot, or dull and spread out
- Make inserting a tampon or getting a gynecological exam uncomfortable
Pelvic pain is chronic if it lasts more than six months and affects your normal activities like work, exercise or having sex.
What Causes Pelvic Pain?
Pelvic pain can be hard to diagnose because the pelvic area in women includes different systems —digestive, reproductive and urinary — along with many muscles, ligaments and nerves. There may be one source of pain or multiple causes.
Some common causes include:
- Aging
- Childbirth
- Endometriosis
- Adenomyosis
- Fibroids
- Genetics
- Hormonal changes
- Injured or irritated nerves
- Scar tissue
- Urinary tract infection
- Weak pelvic floor muscles
Pelvic pain feels different for everyone and your pain level may not relate to how severe the problem is. For instance, a tiny area of endometriosis may cause intense pain for you, while someone else could have extensive endometriosis with little to no pain.
Pelvic pain isn’t something to minimize or try to live with; ignoring it comes with risks. Left untreated, pelvic pain can lead to pelvic inflammatory disease, scarring and fertility problems. Emotional problems can flare too – depression, anxiety, insomnia and intimacy struggles are real.
Your Doctor Wants to Help – Start Talking
Finding relief starts with mustering the courage to talk openly with your doctor about what you’re experiencing. Be prepared to be as specific as possible. You’ll likely be asked questions like:
- Can you describe the pain you’re experiencing?
- Can you rate your pain on a scale from one to 10?
- Does it wake you at night?
- How frequently do you have pain?
- How long have you been experiencing pain?
- What kinds of activities trigger it?
- What makes it worse or better?
- Do you find yourself calling out of work or school due to pain?
Pinpointing the cause of pelvic pain isn’t always clear-cut and can take time. You may even have more than one thing going on. After talking with you and doing a physical exam, your doctor may want tests to gather more information. Diagnostic tools such as ultrasound, laparoscopy and cystoscopy allow for a closer look. With these results, you and your doctor can talk about the treatment that’s right for you.
Treating Pelvic Pain
Thankfully, there are treatment solutions that don’t involve surgery, or if they do, have a minimally invasive approach. The most common treatment options include:
- Diet and lifestyle changes. Changes to your eating and exercise plans.
- Medication. Over the counter and prescription pain relievers and muscle relaxants.
- Physical therapy. Massage, stretching, strengthening and learning how to control pelvic floor muscles.
- Surgery. Minimally invasive procedures to remove adhesions, fibroids or endometriosis.
Finding relief for pelvic pain may mean trying more than one approach or a combination of treatments. If you feel you are not being heard, don’t hesitate to seek a second opinion. It can take time, but opening up to your doctor and working together can lead to brighter days ahead.
Jessica Ton, MD, is board-certified in obstetrics and gynecology. She specializes in minimally invasive gynecologic surgery. Make an appointment by calling 443-481-3493. 
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