Women's health Symptom

Pelvic pain

Pelvic pain — pain felt in the lower abdomen, pelvis or perineum — is a common and often underdiagnosed complaint that affects both women and men. It may be acute or chronic, and has a wide range of potential causes including musculoskeletal, gynaecological, urological and psychological factors. A multidisciplinary approach combining medical assessment with pelvic floor physiotherapy and psychological support tends to produce the best outcomes.

See therapies that may help

What is Pelvic pain?

Chronic pelvic pain (CPP) is defined as pain in the pelvis lasting six months or more that is not exclusively related to menstruation or intercourse. It affects around 1 in 6 women in the UK and is a significant cause of gynaecological outpatient referrals. Men can also experience chronic pelvic pain, often presenting as chronic prostatitis or pelvic floor dysfunction.

Causes of pelvic pain include gynaecological conditions (endometriosis, adenomyosis, ovarian cysts, pelvic inflammatory disease), musculoskeletal dysfunction (pelvic floor hypertonicity or dysfunction), urological causes (interstitial cystitis, bladder pain syndrome), gastrointestinal causes (IBS, adhesions), and neuropathic pain. In many cases, multiple factors contribute simultaneously.

Pelvic pain is significantly influenced by the central nervous system — central sensitisation, the stress response, and psychological factors all modulate pain experience in the pelvis. This makes a purely biomechanical treatment approach frequently insufficient.

Signs and symptoms

Pelvic pain presentations vary widely. Common features include:

Persistent or episodic lower abdominal or pelvic pain
Pain during sexual intercourse (dyspareunia)
Pain with vaginal penetration (in vaginismus)
Bladder pain or urgency
Bowel-related pain or dysfunction
Tailbone pain (coccydynia)
Vulval pain (vulvodynia)
Pain worsening with prolonged sitting, exercise or stress

Persistent pelvic pain should always be assessed medically to rule out underlying pathology. Gynaecological, urological and gastroenterological assessment may all be relevant.

How therapy can help

Best outcomes in chronic pelvic pain come from a multidisciplinary approach:

Pelvic floor physiotherapy — specialist physiotherapy assessing and treating pelvic floor dysfunction, including hypertonicity (excessive tension), weakness and coordination problems. Central to most CPP presentations
CBT and pain management — addressing the psychological maintaining factors, fear-avoidance, catastrophising and the impact of pain on daily life
Mindfulness and acceptance-based approaches — building a different relationship with pelvic pain, reducing the emotional amplification of signals
Osteopathy — whole-body assessment including the pelvis, sacrum and lumbar spine
Acupuncture — some evidence for chronic pelvic pain, particularly for endometriosis-related and bladder pain
EMDR and trauma therapy — for pelvic pain with a trauma component (sexual trauma is associated with pelvic floor dysfunction and chronic pelvic pain)

Seeking help

Chronic pelvic pain deserves thorough medical assessment — a GP referral to gynaecology, urology or a specialist pelvic pain clinic is appropriate. Alongside medical investigation, referral to a specialist pelvic floor physiotherapist should be requested early rather than as a last resort.

Pelvic Pain Support Network (PPSN) offers peer support and resources. The Pelvic, Obstetric and Gynaecological Physiotherapy (POGP) group can help locate specialist pelvic floor physiotherapists.

Therapies that may help with Pelvic pain

Therapy	Evidence	Notes
Cognitive Behavioural Therapist	strong	Evidence-based support for the distress, fear-avoidance and low mood that persistent pelvic pain can cause.
Counsellor	strong	Space to process the emotional impact of ongoing pelvic pain.
EMDR Practitioner	strong	Helps where pelvic pain is linked to trauma, including birth or medical trauma.
ISTDP Practitioner	strong	Addresses emotional patterns that can amplify chronic pelvic pain.
Mindfulness Practitioner	strong	MBSR-style practice that can reduce the suffering and tension around persistent pelvic pain.
Pain Reprocessing Therapist	strong	Targets the brain's pain signals in persistent pelvic pain where no ongoing damage is found.
Physiotherapist	strong	Pelvic-floor physiotherapy is a first-line treatment for many causes of pelvic pain.
Psychotherapist	strong	Deeper support where pelvic pain is entangled with trauma, relationships or distress.
Acupuncturist	moderate	Used as part of broader management for pelvic pain; outcomes vary.
Arts Therapist	moderate	A non-verbal outlet for the frustration and distress of living with pelvic pain.
Biofeedback Practitioner	moderate	Helps retrain the pelvic-floor and stress responses involved in pelvic pain.
Scar Tissue Release Therapist	moderate	Hands-on work on scar tissue (e.g. after surgery or birth) that is contributing to pelvic pain.

Frequently asked questions

What is pelvic floor physiotherapy?

Pelvic floor physiotherapy involves specialist assessment and treatment of the muscles, connective tissue and nerves of the pelvic floor — the group of muscles that support the bladder, bowel and uterus. For chronic pelvic pain, treatment typically involves releasing overactive muscles (hypertonic pelvic floor) through manual therapy, breathing techniques and progressive relaxation, rather than strengthening exercises.

Can stress cause pelvic pain?

Yes — stress is a significant contributor to pelvic pain through multiple mechanisms. The pelvic floor muscles are highly responsive to psychological stress, with many people habitually bracing or tensing their pelvic floor under stress. Central sensitisation — where the nervous system amplifies pain signals — is also worsened by chronic stress. Addressing stress is an important part of pelvic pain management.

Is pelvic pain always gynaecological?

No — while gynaecological causes (endometriosis, adenomyosis, ovarian issues) are important and should be assessed, pelvic pain frequently has musculoskeletal (pelvic floor dysfunction), urological, gastrointestinal, and neurological components. A multidisciplinary assessment is more likely to identify all contributing factors than a purely gynaecological workup.

Can pelvic pain be caused by trauma?

Yes — there is a well-established relationship between trauma (particularly sexual trauma) and chronic pelvic pain. Trauma can cause habitual pelvic floor tension, central sensitisation and psychological factors that all contribute to pain. A trauma-informed approach — including trauma-focused therapy alongside physical treatment — is important for this group.

How long does pelvic floor physiotherapy take?

This depends on the cause and severity of pelvic pain. Many people notice improvement within 6–8 sessions of specialist pelvic floor physiotherapy, though a longer course is often needed for established chronic pelvic pain. Home practice between sessions — relaxation exercises, breathing and progressive desensitisation — significantly affects the pace of recovery.