| One-Minute Clinician

All About Pelvic Pain

There are a lot of different causes of pelvic pain, and there’s never just one cause of pelvic pain. Many times there is more than one or two, three, or four causes in someone who presents with pelvic pain. And it expands all organ systems. It goes from vascular, urological, gynecological, musculoskeletal, neurological, and dermatological. So it becomes really difficult to assess someone with chronic pelvic pain because there could be so many different causes. My practice is dedicated in evaluating and treating women with chronic pelvic pain. Most of my referrals come from primary care or gynecologists who have seen those patients and are unable to identify what may be causing their pain, or having trouble with controlling their pain. It’s estimated about 15% of all women have experienced chronic pelvic pain; some statistics say about 35% of patients who go to a primary care office will have chronic pelvic pain. The first step? A comprehensive evaluation and a very thorough history. A lot of these patients have had pain for many years, so I always like to ask, “How did all of this begin? What were your first type of symptoms?” That takes maybe 30 minutes. From there on it’s a comprehensive examination, trying to identify pain sources or pain triggers on examination. We also work with physical therapists and PM&R physicians who evaluate the patients for musculoskeletal conditions. I think what’s important when we continue our studies of women or men who have chronic pelvic pain is to focus more on identifying sources of pain, to identifying phenotypes of the patients. Because everybody is different in their experience of pain and not everybody is going to respond to certain treatments. I think if we focus our studies in identifying subtypes of patients who have chronic pelvic pain we can then begin to actually formulate better treatment options and studies and medications for them.