How to Talk to Your Doctor about Gynecological Pain, Sexual Pain, Pelvic Pain

Experiencing persistent pain in your pelvis, vagina, or during sex is not only uncomfortable, but may also feel awkward to share. The good news is that doctors are learning more about conditions that cause pelvic and vulvar pain and they have strategies that can relieve your pain.

Even if you’re experiencing chronic pain in your pelvic or vaginal area, you may not be gung-ho to bring it up to your healthcare provider. After all, it’s not like you’re describing a sore back, an aching shoulder, or heel pain. Discussing with your doctor the pain you’re experiencing in the pelvic region, however, is important because a) it’s their job to listen to your concerns, and b) there are a variety of treatments that can help you feel better.

An estimated 25 million women suffer from chronic pelvic pain,  making it one of the most common health problems, according to the International Pelvic Pain Society (IPPS).1

Approximately 25 million women suffer from chronic pelvic pain which can include gynecological pain like vulvodyna, endometriosis, sexual pain, and more. (Image: iStock)

Kinds of Pain That Can Occur in the Pelvic Area, Vulvar Region, or Vagina

“Chronic pelvic pain refers to any pain that occurs in the lower abdomen, lower back, and vaginal area,” says Georgine Lamvu, MD, MPH, professor of Obstetrics and Gynecology at the

University of Central Florida College of Medicineand Chair of the IPPS Board.Such pain can be caused by pelvic organs (such as the bladder, bowel, ovaries, and uterus) or by pelvic muscles and pelvic nerves, which connect the organs and muscles to the spinal cord and the brain, she explains. Typically, chronic pelvic pain means that the pain is persistent and non-cyclic for six months or more.

There are many potential reasons for chronic pelvic pain,3 including but not limited to:

Gynecological causes

  • endometriosis, a condition in which tissue that normally lines the uterus grows outside the uterus
  • pelvic inflammatory disease, infection of the reproductive organs
  • pelvic floor dysfunction, muscular spasms of the pelvic floor muscles
  • vulvodynia, which is pain or discomfort that occurs in the vulvar region

Non-gynecologic causes

  • interstitial cystitis, an inflammatory condition of the bladder
  • irritable bowel syndrome, an intestinal disorder

In about 20% of cases, the cause for chronic pelvic pain is gynecological while, perhaps surprisingly, in 80% of patients, it has a non-gynecological source, says Dr. Lamvu. And, she adds, about 40% of women who have chronic pelvic pain have more than one health condition contributing to the pain.

For example, persistent pelvic pain can be associated with a specific disease but it can also be due to unknown causes or considered a diagnosis of exclusion (meaning, other syndromes must be ruled out to find a proper diagnosis). The latter is the case with vulvodynia, says Meryl Alappattu, PT, DPT, PhD, a research assistant professor at the University of Florida’s Department of Physical Therapy. Dr. Alappattu specializes in chronic pelvic pain conditions.

Endometriosis, in particular, is present in 8 to 10% of women with chronic pelvic pain, Dr. Lamvu says. “Endometriosis always starts as cyclical pain before it progresses to continuous pain,” she explains.

In vulvodynia, the pelvic floor muscles involuntarily contract during intercourse and cause pain, Dr. Lamvu says, adding that, “For this diagnosis, chronic vaginal pain must be present for more than three months.”

How to Talk to Your Doctor about Pelvic Pain or Vaginal Pain

Whether you have gynecological pain, pain with intercourse, or pelvic pain, it’s important to share it with your doctor, advises Dr. Alappattu. “Sometimes patients are embarrassed to bring up the fact that it hurts to have sex or even talk about pain in the pelvic region,” she says. “But the pain can begin to impact one’s quality of life, sexual function, relationships or even the ability to exercise or to work.”

According to the IPPS, nearly 25% of women with persistent pelvic pain spend a few days in bed each month, and more than half cut down on their daily activities at least one day a month. Nearly half of the women with chronic pain in the pelvic region feel depressed or sad some of the time. 

So when you do meet with your doctor, be open and direct, she advises. If you don’t feel like your concerns are being heard or validated, seek care from a provider who specializes in pelvic pain. “You want a provider who will share your concerns about your pain and discuss a plan for addressing it,” says Dr. Alappattu.

Adds Dr. Lamvu: “I would suggest starting with your gynecologist, although many women do not have access to one so primary care is a good option in those cases.” And, she says, keep in mind that fewer than 5% of gynecologists or physical therapists specialize in chronic pelvic pain.

Before you go to the doctor, take a thorough inventory of your pain, says Dr. Lamvu. Keep track of what makes it worse or better, whether it wakes you up at night, and what kinds of activities cause it, she advises. Your doctor will want to know about your emotional state, your relationships, your anxiety level (if any), and even about your work life, she says.

Types of Treatments for Pelvic and Vaginal Pain  

Various therapies are available to treat chronic pelvic pain, says Dr. Alappattu. Physical therapy, medications, cognitive behavioral therapy, and couples counseling all can be effective.

“Sexual therapy also may be recommended as part of your treatment,” says Dr. Alappattu. In some cases, such as for pelvic floor dysfunction, muscle relaxants may be prescribed to relax the pelvic muscles and help the patient better tolerate physical therapy.

It’s important to understand that treatment for chronic pelvic pain may require a few types of approaches, adds Dr. Lamvu, and feeling better can take time.

For example, “It can take 8 to 12 weeks on average to figure out the cause of the pain and to initiate therapy,” Dr. Lamvu says. “Once you start therapy, it can take another 8 to 12 weeks to get better. It’s important for you to be part of the treatment solution by collaborating with your doctor in developing a treatment plan.”

Among the treatments for CPP are pain-relieving drugs such as nonsteroidal anti-inflammatory drugs, physical therapy, acupuncture, and lifestyle changes such as regular exercise and good posture, according to the American College of Obstetricians and Gynecologists (ACOG).4

It’s also key to realize that you can improve, she says. “There are many therapeutic options to improve your pain and your quality of life,” Dr. Lamvu explains. “So get educated, be patient with yourself, and don’t give up.”

Updated on: 05/15/20
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