What It Means and How to Find Relief
Chronic pelvic pain means discomfort in your pelvic area (between your belly button and thighs) that lasts more than six months. It can be confusing and frustrating – after many doctor visits and tests, you might still hurt. You may feel like no one understands how much it affects your life. The good news is that you are not alone and there are many reasons for this pain. In fact, experts say it usually takes a multidisciplinary approach to make progress. In other words, many different types of providers and treatments working together can bring relief.
Pelvic Floor Dysfunction
The pelvic floor is a hammock of muscles and ligaments under the bladder and uterus. When those muscles get too tight, weak, or “twitchy,” they can cause pain and make existing pain worse. Studies show pelvic floor muscles often act as both a source of pain and a protective brace in chronic pelvic pain. For example, pelvic tension commonly appears in women with conditions like endometriosis or painful bladder (IC). Signs that your pelvic floor might be involved include burning or aching in the vagina or rectum, feeling like you’re sitting on a golf ball, or pain when holding in urine or stool.
- Deep pelvic pressure or aching, often worse with sitting
- Burning, stinging, or rawness around the genital area
- Pain or burning during urination or bowel movements
- Painful insertion (tampons or intercourse) and difficulty with bowel movements
Many women with chronic pelvic pain feel these symptoms. The good news is gentle, specialized physical therapy can help retrain these muscles and ease the pain. A pelvic floor physical therapist can teach you how to relax and lengthen tight muscles (through stretching, breathing, and biofeedback) as well as gently strengthen weak areas. With skilled care, the pelvic floor can learn to support your organs without hurting you.
Painful Intercourse or Insertion (Dyspareunia)
Pain with penetration or intercourse (often called dyspareunia) is very common – it affects about 10–20% of women. It can feel sharp, burning, cramping, or like a deep ache. Many factors can cause this pain. For example, not enough vaginal lubrication (common around menopause or with certain medications), skin inflammation, or infections can make sex hurt. In other cases, the pelvic floor muscles clamp down involuntarily (a condition sometimes called vaginismus). Even internal issues like endometriosis, fibroids, or scar tissue can cause deep pain with sex.
- Lack of lubrication or vaginal dryness (especially with hormonal changes)
- Tight or spastic pelvic floor muscles (making penetration painful)
- Inflammation or infection of vaginal tissue
- Uterine issues (fibroids, prolapse) or conditions like endometriosis
If tampon insertion or gentle touch causes a sharp or burning pain, a pelvic floor therapist can help. Treatments might include pelvic relaxation techniques, gradual use of vaginal dilators (small cones), lubricants, and counseling. This kind of pain can be scary, but it can improve with the right care and patience.
Endometriosis
Endometriosis happens when tissue like the uterine lining grows outside the uterus (on ovaries, bowel, or ligaments). It causes severe cramps, heavy bleeding, and chronic pain, often in the lower belly or back. About 10% of women have endometriosis worldwide, and it’s a leading cause of pelvic pain. In fact, up to one-third of women with chronic pelvic pain are found to have endometriosis.
Endometriosis can be hard to diagnose, sometimes taking years. If you have very painful periods, pain with intercourse or bowel movements, or have been told about cysts on your ovaries, endometriosis might be part of your story. Even after medical or surgical treatment, many women still experience pain because the surrounding muscles and nerves have been sensitized. That’s why pelvic floor therapy and gentle movement can be so important — relaxing tight muscles and improving posture around the pelvis can lessen pain.
Pelvic Organ Prolapse
A pelvic organ prolapse (POP) is when organs like the bladder, uterus, or rectum shift down into the vagina because the pelvic floor support is weak. This can happen from childbirth, aging, or heavy lifting. Prolapse is very common (affecting maybe 3–11% of women) and many women don’t even know they have it.
Symptoms of prolapse can include a feeling of pressure or fullness in the pelvis (“like something is falling out”), discomfort in the vaginal area, and sometimes pain during sex. Even if you feel a bulge, you might only feel achiness or nothing at all. The key point: you’re not alone or abnormal. There are treatments to help. Pelvic floor therapy can strengthen your muscles to better support your organs. In some cases, a pessary (a small device placed in the vagina) or surgery is recommended, but often physical therapy and lifestyle changes can make you feel much better without immediately needing surgery.
Polycystic Ovary Syndrome (PCOS)
PCOS is mainly a hormonal disorder (irregular periods, cysts on ovaries, excess androgens), but it can cause pelvic discomfort. About 10% of reproductive-age women have PCOS. Women with PCOS often have heavy or painful periods – nearly 30% report pelvic pain or cramps as a symptom of PCOS . The pain usually comes from thickened uterine lining (from long cycles) or enlarged ovaries with cysts pressing in the pelvis.
While PCOS isn’t traditionally grouped with “pelvic pain syndromes,” it can definitely contribute. If PCOS is part of your health picture, managing it (through diet, exercise, and medications to balance hormones) often eases pelvic pain. For example, regulating insulin and menstrual cycles can reduce heavy bleeding and cramping. Your pelvic floor also may feel better when hormonal balance improves.
Painful Bladder Syndrome / Interstitial Cystitis (IC)
Interstitial cystitis (IC), also called painful bladder syndrome, is a chronic condition causing bladder and pelvic pain. Women often describe it as a constant pressure or burning pain in the bladder or between the vagina and anus. You may feel an urgent need to pee many times a day, even though tests show no infection.
IC affects a significant number of women (estimated roughly 3–6% of women). The symptoms often flare with triggers like menstruation, stress, or certain foods. One key thing: IC and pelvic floor dysfunction go hand-in-hand. In fact, up to 85% of people with IC have pelvic floor muscle trigger points or spasm. This means your pelvic muscles may tighten around the bladder, adding to discomfort.
Treatment typically involves bladder retraining (scheduled voids), diet changes (avoiding caffeine, spicy foods, alcohol), and crucially, pelvic floor therapy. Learning to relax and support your pelvic muscles can dramatically reduce bladder-related pain. A gentle approach, with a therapist who understands IC, is important so you don’t make the bladder more sensitive.
Vulvodynia
Vulvodynia is chronic pain of the vulva (the external genital area) without a clear cause. It feels like burning, stinging, or rawness at or around the vaginal opening. It may be constant or triggered by things like sitting, tight clothing, or touch. It’s much more common than most people realize – by age 40 about 7–8% of women will have had vulvar pain consistent with vulvodynia.
Having vulvodynia can feel isolating, especially if doctors say “everything looks normal.” But your pain is real, even if it doesn’t show up on tests. Vulvodynia often overlaps with painful intercourse (the vestibule area can be very tender). Treatment is usually multimodal: specialized pelvic floor therapy (to desensitize and strengthen muscles), gentle topical treatments, and sometimes nerve pain medications. Behavioral techniques (like biofeedback, relaxation, or hypnotherapy) are also very helpful in soothing the nervous system. With support and time, many women see significant improvement.
Postpartum Tailbone Pain
If you’ve given birth, you might have experienced tailbone (coccyx) pain afterward – medically known as postpartum coccydynia. During a long or difficult delivery, the coccyx can be bruised or strained. Having a large baby, a baby in a posterior position, or a narrow pelvis can increase the risk.
Symptoms include a sharp or aching pain at the very bottom of the spine, especially when sitting or leaning back. You might feel it getting worse after nursing sessions or long periods of sitting. The good news is this usually improves. Using a donut pillow or sitting forward can ease the pressure, and gentle stretches and posture changes help. Pelvic floor therapists can guide you in safe movements and use manual techniques to relieve tailbone pain. With proper care, most women recover their comfort in a few months postpartum.
Working with a Care Team
Because chronic pelvic pain can arise from many sources, healing often involves a team. No single doctor has all the answers, so it helps to have different specialists working together. A typical care team might include obstetrician/gynecologists, urologists, physical therapists, and more. Here are some roles to know:
| Care Team Member | How They Help You |
|---|---|
| Pelvic Floor Physical Therapist | This is often the foundation of care. They assess and treat your pelvic muscles, teach you how to relax tight muscles and strengthen weak ones, and use techniques (biofeedback, massage, nerve gliding, etc.) to reduce pain. |
| Gynecologist / OB-GYN | Examines you for uterine or ovarian causes (like endometriosis, fibroids, or prolapse). They manage menstrual or hormonal issues and can coordinate treatments like medications or surgery if needed. |
| Urologist | Evaluates bladder problems (recurrent UTIs vs. IC). They can offer bladder treatments or nerve therapies for pelvic pain related to urinary symptoms. |
| Gastroenterologist | Looks at bowel issues (IBS, constipation, inflammatory bowel disease) which often accompany pelvic pain. Treating gut health can lessen pelvic pain. |
| Pain Management Specialist | Provides medications or injections (like nerve blocks or neuromodulation) if pain is severe. Works alongside other treatments for better relief. |
| Mental Health Professional | Helps with the emotional and stress side of chronic pain (anxiety, depression, trauma). Therapies like cognitive-behavioral therapy (CBT), relaxation training, or mindfulness can actually change how your brain perceives pain. |
| Nutritionist / Dietitian | Guides diet changes (e.g., anti-inflammatory diet, bladder/IBS triggers elimination) that can reduce pain. |
| Yoga / Movement Specialist | Leads gentle exercises and stretches tailored to pelvic health, improving posture and core support without flaring pain. |
No matter what mix of doctors or therapists you see, physical therapy is usually central. Research shows that “multimodal physical therapy” (working on muscles, joints, nerves, and movement together) significantly reduces chronic pelvic pain. At the same time, treatments that calm your nervous system are key. Practices like mindful breathing, meditation, or guided imagery fall under psychophysiological therapy and can lower pain intensity.
Remember, healing is a journey. It often means moving slowly, pacing activities, and giving yourself permission to rest when needed. Small changes—like taking short breaks during chores, using heat or gentle stretches daily, and reducing inflammation in your diet—can build up to big improvements.
Next Steps Checklist
Here are some positive actions you can take right now:
- Believe Your Pain is Real. You’ve likely been told “it’s all in your head,” but your pain has real physical roots. You deserve help and relief.
- Find a Specialized Pelvic Floor Therapist. A therapist trained in pelvic health can evaluate all the causes above and start gentle treatment right away. (Use the resources below to find one in your area.)
- Track Your Symptoms. Keep a simple diary of your pain: when it hurts, what you were doing, foods you ate, etc. This helps you and your caregivers spot patterns or triggers.
- Communicate with Your Doctor. Make a list of your symptoms and frustrations before appointments. Ask about each possible cause – from bladder issues to endometriosis – so you know what to check.
- Practice Gentle Movement. Try slow walks, pelvic tilts, yoga, or stretching routines that feel comfortable. Movement helps blood flow and flexibility. Remember “less is more” at first.
- Pace Yourself. Break tasks into small steps and rest between them. Overdoing it can cause flare-ups, so work within your energy level.
- Support Your Nervous System. Explore relaxation techniques (deep breathing, meditation, warm baths) and consider counseling or support groups. Stress and emotions can amplify pain, so self-care and community matter.
- Use Good Posture. Sit on a cushion or well-supported seat. Stand up and move every 30 minutes if you sit a lot. Proper support can ease pressure on the pelvic floor and tailbone.
- Ask About Medications and Supplements. For example, non-prescription anti-inflammatories can help some pains (talk to your doctor), and a calcium-magnesium supplement may ease muscle tension.
- Join a Support Network. Connecting with others who have pelvic pain can make you feel understood and give ideas for coping.
Trusted Resources
For help finding a qualified pelvic floor physical therapist, try these directories:
- APTA Pelvic Health PT Locator: aptapelvichealth.org/ptlocator
- Pelvic Global Directory: pelvicglobal.com
You may also find helpful information and communities online, such as the International Pelvic Pain Society or patient support forums.
You are not broken or alone. Healing chronic pelvic pain often takes time and a mix of therapies, but many women find real relief. By learning about the causes, seeking the right care team, and caring for your body and mind, you can move toward feeling better. Stay hopeful and keep advocating for yourself – your body is listening, and it wants to heal.
Sources: Reputable medical and research sources have informed this guide, including clinical articles and expert reviews
genesisobgyn.netmy.clevelandclinic.org
mayoclinic.orgpmc.ncbi.nlm.nih.gov
