Pelvic Pain
Pelvic Pain in Women: Causes, Diagnosis, and Expert Care
Pelvic pain is one of the most common — and most underdiagnosed — conditions affecting women. It can be sharp or dull, constant or intermittent, localized or widespread. It may flare during your period, during intercourse, during urination, or without any clear trigger. And yet many women spend years searching for an answer before finding the specialized care they need. Delay in diagnosis not only causes continuedSuffering, but often make subsequent treatment more challenging.
At Boston Urogyn, Dr. Neeraj Kohli and his team focus exclusively on women’s pelvic health. We have the diagnostic tools, clinical experience, and treatment options to identify the root cause of your pain — and to treat it effectively.
What Is Pelvic Pain?
Pelvic pain refers to any discomfort, pressure, or pain that occurs in the lower abdomen, pelvis, or perineal region. It is considered chronic when it persists for six months or more, though even acute or cyclical pelvic pain deserves evaluation.
Pelvic pain is not a diagnosis in itself — it is a symptom. The goal of a thorough evaluation is to determine which underlying condition is responsible so treatment can be directed at the source, not just the symptom. Boston Urogyn specializes in root cause analysis and treatment, not symptom management.
Common Causes of Pelvic Pain in Women
The pelvis is a complex anatomical region, and pelvic pain can originate from the reproductive, urinary, musculoskeletal, or gastrointestinal systems. Common causes include:
- Endometriosis — tissue that resembles the uterine lining grows outside the uterus, causing inflammation, scarring, and pain that often worsens with menstruation
- Interstitial cystitis (painful bladder syndrome) — chronic bladder inflammation that causes pelvic pressure, urgency, and pain that mimics recurrent UTIs
- Pelvic floor dysfunction — abnormal tension or weakness in the pelvic floor muscles, which support the bladder, uterus, and rectum
- Vulvodynia and vestibulodynia — chronic vulvar pain or burning without an identifiable cause
- Uterine fibroids or ovarian cysts — benign growths that can cause pressure, bloating, and pelvic discomfort
- Pelvic inflammatory disease (PID) — infection of the reproductive organs, often from untreated STIs
- Pelvic congestion syndrome — varicose veins within the pelvis that cause a persistent, aching pain
- Adhesions — scar tissue from prior surgeries or infections that can bind pelvic organs and restrict movement
- Vaginismus — involuntary muscle spasm that makes penetration painful or impossible
- GSM – Genitourinary syndrome of menopause can often cause pelvic pain And pain with intercourse due to vaginal drynessAn increased risk of infection.
In many cases, more than one condition is contributing. Up to 80% of women with endometriosis also have hypertonic pelvic floor dysfunction, which is typically left untreated and therefore symptoms fail to improve despite various surgeries and medications for endometriosis. Too many women have been labeled as having endometriosis or vaginal infections when they truly have underlying pelvic floor dysfunction, which is easily diagnosed and treatable. A thorough, systematic evaluation with a pelvic floor specialist is essential.
When Pelvic Pain Is More Than "Just Cramps"
Many women are told their pelvic pain is normal, especially if it is associated with their menstrual cycle. In reality, pain that interferes with daily life, intimacy, work, or physical activity is not something to simply tolerate. You deserve answers and effective care.
Signs that your pelvic pain warrants specialist evaluation include:
- Pain that has persisted for three months or longer
- Pain that has gradually worsened over time
- Discomfort or pain during or after intercourse
- Pain with urination or a sense of bladder pressure that does not resolve
- Pain that disrupts sleep or limits physical activity
- Difficulty inserting tampons or undergoing routine gynecological exams
- Pelvic pain following a surgery, delivery, or pelvic infection
- Continuous pelvic pain with negative evaluation, including imaging studies and Test results.
How Boston Urogyn Evaluates Pelvic Pain
Our approach begins with listening. Your history — when the pain started, what makes it better or worse, how it affects your life — is essential diagnostic information. We also do a thorough Assessment of your past evaluation and treatments by reviewing medical records.
From there, your evaluation at Boston Urogyn may include:
- A detailed pelvic examination, including assessment of muscle tone and tenderness
- Pelvic floor muscle assessment to identify dysfunction or trigger points
- Urodynamic testing when bladder involvement is suspected
- Pelvic ultrasound or advanced imaging to visualize reproductive structures
- Laboratory work to evaluate for infection, hormonal factors, or inflammatory markers
We work to identify the root cause of your pain — not to manage symptoms indefinitely.
Treatment Options for Pelvic Pain at Boston Urogyn
Treatment is individualized based on your diagnosis, symptoms, and goals. Options may include:
- Compounded vaginal suppositories – specifically developed by Boston Urogyn can often provide significant and safe relief in patients with hypertonic pelvic floor dysfunction.
- Pelvic floor physical therapy to address muscle dysfunction, tension, or weakness
- Sola Pelvic Therapy — a non-invasive neuromuscular stimulation therapy for pelvic floor rehabilitation
- EMSELLA — a hands-free device that uses high-intensity focused electromagnetic energy to strengthen or relax the pelvic floor
- THERMiVa — radiofrequency therapy for vaginal tissue health and pelvic comfort
- MonaLisa Touch — fractional CO2 laser treatment to restore vaginal tissue health affected by hormonal changes
- Biote hormone pellet therapy for patients whose pelvic pain is linked to hormonal imbalance
- Trigger point injections and nerve blocks for targeted pain relief
- Minimally invasive surgical options when anatomical causes such as endometriosis or fibroids require intervention
Many patients find meaningful relief through a combination of in-office treatments and guided pelvic rehabilitation. BosonUrogyn will work with you to build a customized plan that fits your diagnosis and your life.
Pelvic Pain and Painful Intercourse
Dyspareunia — painful intercourse — is one of the most common and least discussed symptoms our patients bring to us. It affects up to one in five women at some point in their lives and is almost always treatable when properly diagnosed.
Pain during intercourse may be superficial (at the vaginal opening) or deep (within the pelvis). Each type has distinct causes and responds to different treatments. Our providers are experienced in evaluating both, without judgment and with the goal of restoring your comfort and intimacy.
Frequently Asked Questions
Is pelvic pain normal?
Mild discomfort around menstruation is common, but pain that is severe, persistent, or disrupting your daily life is not something you have to accept. Chronic pelvic pain always deserves evaluation.
Can pelvic pain be treated without surgery?
In most cases, yes. The majority of our patients find significant relief through non-surgical approaches including pelvic floor therapy, in-office procedures, and targeted treatment of the underlying cause. Surgery is considered when anatomical causes require it.
How long does it take to find relief?
This depends on the underlying diagnosis and the treatment approach. Some patients experience meaningful improvement within a few weeks; others require a longer course of treatment. We will set realistic expectations during your initial consultation and prognostic indicators.
Do I need a referral to see Dr. Kohli?
Most patients do not require a referral, though we recommend checking with your insurance plan. You can contact our office directly to schedule an initial consultation.
Ready to Find Answers?
Pelvic pain does not have to be a permanent part of your life. If you have been living with discomfort, avoiding activities you love, or feeling dismissed by providers who could not find the cause, Boston Urogyn is here to help.
Call us at (617) 340-6446 or use our online booking to schedule a consultation with Dr. Kohli. With offices in Wellesley and Hudson, MA, Boston Urogyn treats patients from all over New England,but also across the country and across the world.