Diagnosing Pelvic Pain: What Causes Chronic Pelvic Pain in Women?

This is an exhaustive list of different causes of chronic pelvic pain. This will be updated throughout 2022 to raise awareness of pelvic pain in women. Women of all ages need to be aware that they are not alone and others are suffering from similar conditions. The Center for Vascular Medicine is here to assist women in diagnosing and treating pelvic pain of a vascular origin and direct them to other specialists when necessary. 

1. Pelvic Congestion Syndrome Symptoms
   • Pelvic pain for greater than 6 months.
   • Incidence of Chronic Pelvic Pain
     • 2% to 10% of gynecological consultations
     • 20% of Laparoscopies performed
     • Up to 40% caused by Pelvic Venous Insufficiency – dysfunction of veins of the pelvis.
   • The common symptoms of this condition.
     • Onset after second or third pregnancies. Multiple pregnancies are common but not necessary. 
     • Pelvic bloating is not associated with menses.
     • Dyspareunia (painful vaginal intercourse). This is very common with patients with this condition. 
     • Post-coital pain (pain after sexual intercourse) can last up to hours after intercourse.
     • Avoidance of intercourse due to fear of pain. Intimacy issues with a spouse.
     • Increase in urination (Nocturia). 
     • Mid-epigastric pain (upper abdomen below the ribs) with or without the above symptoms.

       Signs often present in Pelvic Congestion Syndrome (PCS) or Pelvic Venous Insufficiency (PVI) patients. 

• Vulvar varicosities
• Supra pubic varicosities
• Medial thigh varicosities
• Gluteal fold varicosities
• Lateral thigh and lower extremity varicosities
• Vaginal edema and varices on vagina on speculum exam

There are other causes of chronic pelvic pain in women. This is a reason why it is best to seek a gynecological evaluation before considering a vascular assessment with a trained specialist.

1. Gynecologic - Lower abdomen pain and/or pelvic pain in females is caused by a disorder of the female reproductive organs. Pregnancy can cause pelvic pain so most pelvic pain is gynecologic in nature. This is why The Center for Vascular Medicine first advises visiting your gynecologist before doing a pelvic evaluation with a vascular specialist. 
2. Endometriosis - In this condition, extra tissue grows outside the uterus. The extra tissue develops in the fallopian tubes or the intestines. This is a common condition that causes chronic pelvic pain.
3. Chronic pelvic inflammatory disease - This is an infection of one or more reproductive organs. Women who are sexually active are particularly susceptible to this disease, causing painful pelvic pain.
4. Fibroids - These are abnormal, noncancerous tumors that grow in or on the women's uterus. This may cause pelvic pressure or pain. This is a common cause of pelvic pain.
5. Ovarian cysts - These are solid or fluid-filled sac within or on the surface of an ovary. These cysts usually go away on their own in a few months. It causes pain during intercourse and menstrual irregularities. 
6. Pelvic adhesions - These are bands of scar tissue that may cause internal organs to stick together. This may also cause bowel obstruction and inability to pass gas. 
7. Uterine prolapsed  - This occurs when the muscles and tissue in your pelvic weaken. This causes the uterus to drop down to the vagina. The patient will feel fullness in the pelvic region, bulging in the patient's vagina, lower-back pain, and constipation.
8. Urologic - Chronic pain in the pelvic region or genitalia that is often accompanied by urinary frequency and urgency. 
   1. Interstitial cystitis - This is often mistaken for a urinary tract infection but no infection is found. It is accompanied by painful bladder pressure and frequent urination. 
   2. Recurrent urinary tract infections - reinfection of the same urinary system, the kidneys, bladder, or urethra. 
   3. Urethral diverticulum - Symptoms include burning sensation with urination, painful intercourse. The patient may have blood in urine, vaginal discharge, and a complaint of vaginal mass. 
   4.  
9. Neurological pelvic pain - This occurs when there is damage to the nerve in the pelvic region. It is described as a burning or stabbing sensation. Certain activities like sitting or standing may increase symptoms. 
   • Neuralgia of ilioinguinal, genitofemoral, or pudendal nerves - this is one of the most common causes of lower abdominal and pelvic pain. Patients describe it as burning pain and numbness over the lower abdomen that radiates to the genitalia and into the inner thigh. 
   • Neuropathic pain - 
   • Herniated nucleus pulposus
   • Abdominal epilepsy/migraine
10. Gastroenterology
    1. Irritable bowel syndrome
    2. Inflammatory bowel disease
    3. Diverticular disease
    4. Chronic constipation
    5. Hernia
11. Hematology/oncology
    1. Cancer or metastases
    2. Porphyria
    3. Fibromyalgia
    4. Sacroiliac joint pain
    5. Hip joint pathology
    6. Fractured coccyx
12. Musculoskeletal
    1. Pelvic floor myalgia
    2. Myofascial pain (trigger points)
    3. Piriformis syndrome
    4. Psoas inflammation
13. Psychiatric
    1. Major depression
    2. Somatization
    3. Sleep disorder
    4. Physical, sexual or substance abuse