Chronic pelvic pain is not "in your head," not "just stress," and not something you should accept as normal. It is a symptom that requires investigation.
Chronic pelvic pain - defined as pain below the navel and between the hips lasting six months or more - affects approximately 1 in 7 women. It is a symptom, not a diagnosis. It can arise from gynecologic, musculoskeletal, neurologic, urologic, or gastrointestinal sources, and frequently from more than one of these simultaneously. Yet women with CPP are routinely told their pain is stress-related, offered antidepressants without a physical workup, or dismissed entirely after imaging comes back "normal."
Normal imaging does not mean normal tissue. Endometriosis, pelvic floor dysfunction, pudendal neuralgia, and interstitial cystitis are frequently invisible on standard ultrasound or MRI. Normal imaging combined with significant pain means the evaluation needs to go further - not that the pain isn't real.
The systems that can cause chronic pelvic pain
Gynecologic
Endometriosis, adenomyosis, ovarian cysts, fibroids, pelvic adhesionsOften missed on imaging; laparoscopy may be needed for diagnosis.
Musculoskeletal
Hypertonic pelvic floor, myofascial trigger points, sacroiliac dysfunctionVery common and frequently undertreated; requires pelvic floor assessment.
Neurologic
Pudendal neuralgia, ilioinguinal nerve entrapment, central sensitizationPain worsened by sitting, positional changes, or specific movements is a key clue.
Urologic
Interstitial cystitis/bladder pain syndrome, recurrent UTIsBladder-related pain that worsens with filling and improves temporarily after voiding.
Gastrointestinal
IBS, pelvic floor outlet obstructionGut symptoms co-occur with CPP in a significant proportion of patients.
Hormonal
Hormonal deficiency, atrophy, cyclical hormonal painEstrogen and testosterone both modulate pain sensitivity in pelvic tissues.
Frequently asked questions
What is chronic pelvic pain?
Chronic pelvic pain is persistent or recurring pain below the navel lasting 6+ months. It is a symptom, not a diagnosis - meaning it requires thorough investigation of all contributing systems to identify and treat underlying causes. It is one of the most common yet most undertreated conditions in women's health.
Can pelvic pain be "normal"?
No. Pain that disrupts daily function, work, sleep, or intimacy is not normal regardless of how often it's dismissed. Mild cramping with menstruation exists on a spectrum, but chronic, recurring, or severe pelvic pain has causes that can and should be identified. "Normal" is not a diagnosis.
My imaging was normal. Does that mean nothing is wrong?
No. Endometriosis, pelvic floor dysfunction, pudendal neuralgia, and interstitial cystitis are frequently invisible on standard imaging. Normal ultrasound or MRI in the context of significant chronic pelvic pain means the evaluation needs to go deeper - not that the pain is imaginary.
What does a comprehensive evaluation include?
A thorough evaluation includes detailed pain history, pelvic exam with pelvic floor assessment, hormonal evaluation, targeted imaging, evaluation for endometriosis, neurologic assessment, urologic and GI screening, and physical therapy assessment. The goal is to identify all contributing systems simultaneously.
What treatments are available?
Treatment is individualized to identified causes: hormonal therapy for endometriosis, pelvic floor PT for musculoskeletal contributors, nerve blocks for neurologic pain, medications for central sensitization, surgical treatment for endometriosis or adhesions, and pain management strategies. Most women with CPP benefit from addressing multiple contributing factors simultaneously.
Chronic pelvic pain has causes. Those causes are findable. And many are very treatable.
Dr. Toubi's Beverly Hills practice provides the comprehensive, multisystem evaluation that chronic pelvic pain requires - not a rushed visit that ends with a shrug and a painkiller.
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Pelvic pain specialistBeverly HillsMultidisciplinary approach
