A Real Pain In... the Vulva

Understanding Chronic Pelvic Pain in Women: A Comprehensive Guide

Chronic pelvic pain in women is more common than many realize. In fact, 1 in 5 women will experience pelvic pain at some point in their lives. However, it is still not well understood. Although research is ongoing, we have attempted to summarize some fundamental points for you!

What Is Chronic Pelvic Pain?

Chronic pelvic pain is defined as pain in the lower abdomen or pelvic region that lasts for six months or more. This pain may be constant or intermittent. It can significantly affect your daily life, intimate relationships, bladder and bowel function, mental health, and mood.

A sub-classification of chronic pelvic pain that we often see in clinics is Genito-Pelvic Pain/Penetration Disorder (GPPPD). According to the DSM-5, this diagnosis applies when one or more of the following symptoms persist for at least six months and cause distress:

• Difficulty with vaginal penetration

• Pain during sex or attempted penetration

• Fear or anxiety about penetration

• Involuntary pelvic floor muscle tension

  
  

For example, this can manifest as pain with tampon use or during intercourse.

What Causes Vulvar or Pelvic Pain?

Pelvic pain rarely has a single cause. It often involves multiple systems, including musculoskeletal, neurological, hormonal, and emotional factors. A thorough assessment by your GP, pelvic health physiotherapist, and other care providers is key to understanding and managing your symptoms.

1. Pathological Conditions

Certain health conditions may irritate or sensitize pelvic tissues. These include:

• Endometriosis or Adenomyosis

• Dermatological conditions such as Lichen Sclerosis

• Recurrent infections, such as thrush (candida) or UTIs

• Low estrogen levels, which can occur post-menopause, postpartum, or due to contraception

  
  

These conditions may cause burning, itching, irritation, or pain with touch, pressure, or penetration.

2. Nerve Pain

Nerve-related issues, such as pudendal neuralgia or perineal nerve irritation, can result in:

• Sharp, shooting, or burning pain

• Pins and needles sensations

• Pain that worsens with sitting or cycling

  
  

This nerve pain may stem from trauma or compression, such as tailbone injuries, surgical scarring, or vaginal deliveries.

3. Bladder and Bowel Concerns

Pelvic pain often overlaps with bladder and bowel symptoms, including:

• Bladder symptoms: urgency, high frequency, nocturia (waking at night to urinate)

• Bowel symptoms: irritable bowel syndrome, constipation, straining, or difficulty emptying

  
  

These symptoms are frequently linked to pelvic floor muscle dysfunction.

4. Pelvic Floor Muscle Dysfunction

Pelvic floor muscles may become tight, overactive, or poorly coordinated. This can happen in response to:

• Bladder and bowel function issues

• Past trauma or pain

• Chronic stress or anxiety

  
  

Known as non-neurogenic hypertonicity, this tension can contribute significantly to pain and limit function. This is typically the physiotherapist's field, where we can assess and guide strategies to release and retrain these muscles.

5. Central Sensitisation

Sometimes, the nervous system itself becomes more sensitive to pain—a process known as central sensitisation. Common signs include:

• Widespread or unexplained pain

• Symptoms that don’t match imaging or test results

• Heightened sensitivity to touch

• Emotional or psychological triggers that intensify pain

  
  
  
  

Central sensitisation is often influenced by past experiences, beliefs, or cultural conditioning. Our identities, cultural backgrounds, and religious values can all shape how we experience and perceive pelvic pain.

Don’t Ignore Your Pain

Pelvic pain is real, valid, and most importantly, treatable. Whether your symptoms are recent or long-standing, pelvic physiotherapy can help restore comfort, function, and confidence. You don’t have to figure it out alone.

Seeking Help

If you are experiencing chronic pelvic pain, it is crucial to seek help. A healthcare professional can provide a thorough assessment and develop a tailored treatment plan. This may include physiotherapy, medication, or other interventions.

The Role of Physiotherapy

Physiotherapy plays a vital role in managing chronic pelvic pain. A pelvic physiotherapist can help identify the underlying causes of your pain and develop strategies to alleviate it. They can guide you through exercises to strengthen or relax pelvic floor muscles, improving your overall function and comfort.

Lifestyle Changes

In addition to professional treatment, certain lifestyle changes can also help manage pelvic pain. Consider incorporating the following into your routine:

• Regular exercise: Gentle activities like walking or swimming can improve overall health and reduce pain.

• Stress management: Techniques such as yoga, meditation, or deep breathing can help alleviate stress and tension.

• Healthy diet: A balanced diet can support overall well-being and may help reduce inflammation.

  
  

Support Networks

Connecting with others who understand what you are going through can be incredibly beneficial. Support groups, whether in-person or online, can provide a safe space to share experiences and coping strategies.

📍 In-person and telehealth appointments available across Australia

🔗 Read more on navigating pelvic pain

👉 Book an appointment with a women’s pelvic physiotherapist

By Liana McMorrow