Chronic Pelvic Pain in Women

Updated: Mar 17, 2023
  • Author: Manish K Singh, MD; Chief Editor: Michel E Rivlin, MD  more...
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Practice Essentials

Chronic pelvic pain (CPP) is a common problem and presents a major challenge to health care providers because of its unclear etiology, complex natural history, and poor response to therapy.

The American College of Obstetricians and Gynecologists (ACOG) defines chronic pelvic pain as continuous or noncyclical pelvic pain of longer than 6 months’ duration that localizes to the anatomic pelvis, abdominal wall at or below the umbilicus, lumbosacral back, or the buttocks and is of sufficient severity to cause functional disability or lead to medical care. [1]

The pathophysiology of chronic pelvic pain is complex and multifactorial. It remains unclear.

Chronic pelvic pain is poorly understood and, consequently, poorly managed. This condition is best managed using a multidisciplinary approach. Management requires good integration and knowledge of all pelvic organ systems and other systems including musculoskeletal, neurologic, and psychiatric systems.

A significant number of these patients may have various associated problems, including bladder or bowel dysfunction, sexual dysfunction, and other systemic or constitutional symptoms. Other associated problems, such as depression, anxiety, and drug addiction, may also coexist.

In the United States, estimated direct medical costs for outpatient visits for chronic pelvic pain (women aged 18-50 y) is approximately $881.5 million per year. [2]



Various reproductive, GI, urologic, and neuromuscular disorders may cause or contribute to chronic pelvic pain. Sometimes, multiple contributing factors may exist in a single patient. About 50-90% of patients with chronic pelvic pain have musculoskeletal pain and dysfunction. [3]

Extrauterine reproductive disorders include the following:

  • Adhesions

  • Adnexal cysts

  • Chlamydial endometritis or salpingitis

  • Endosalpingiosis

  • Ovarian retention syndrome (residual ovary syndrome)

  • Ovarian remnant syndrome

  • Ovarian dystrophy or ovulatory pain

  • Pelvic congestion syndrome

  • Postoperative peritoneal cysts

  • Residual accessory ovary

  • Subacute salpingo-oophoritis

  • Tuberculous salpingitis

Uterine reproductive disorders include the following:

  • Adenomyosis

  • Chronic endometritis

  • Atypical dysmenorrhea or ovulatory pain

  • Cervical stenosis

  • Endometrial or cervical polyps

  • Leiomyomata

  • Symptomatic pelvic relaxation (genital prolapse)

  • Intrauterine contraceptive device

Urologic disorders include the following:

  • Bladder neoplasm

  • Interstitial cystitis

  • Radiation cystitis

  • Recurrent cystitis

  • Recurrent urethritis

  • Urolithiasis

  • Uninhibited bladder contractions (detrusor-sphincter dyssynergia)

  • Urethral diverticulum

  • Chronic urethral syndrome

  • Urethral caruncle

Musculoskeletal disorders include the following:

  • Abdominal wall myofascial pain (trigger points)

  • Compression fracture of lumbar vertebrae

  • Faulty or poor posture

  • Mechanical low back pain

  • Chronic coccygeal pain

  • Muscular strains and sprains

  • Pelvic floor myalgia (levator ani spasm)

  • Piriformis syndrome

  • Rectus tendon strain

  • Hernias (eg, obturator, sciatic, inguinal, femoral, spigelian, perineal, umbilical)

Gastrointestinal disorders include the following:

Neurologic disorders include the following:

  • Neuralgia/cutaneous nerve entrapment (surgical scar in the lower part of the abdomen; usually iliohypogastric, ilioinguinal, genitofemoral, and lateral femoral cutaneous nerves)

  • Shingles (herpes zoster infection)

  • Degenerative joint disease

  • Disk herniation

  • Spondylosis

  • Abdominal epilepsy

  • Abdominal migraine

  • Neoplasia of spinal cord or sacral nerve

Psychologic and other disorders include the following:

  • Personality disorders

  • Sleep disorders

  • Sexual and/or physical abuse

Common causes of chronic pelvic pain in men include the following:

  • Chronic (nonbacterial) prostatitis

  • Chronic orchalgia

  • Prostatodynia



United States statistics

Chronic pelvic pain is a common problem. It affects approximately 1 in 7 women. [2] In one study of reproductive-aged women in primary care practices, the reported prevalence rate of pelvic pain was 39%. [4] Of all referrals to gynecologists, 10% are for pelvic pain. [5]

International statistics

A similar prevalence of chronic pelvic pain has been described in other countries. [6]

Race-, sex-, and age-related demographics


In one study, Blacks had a higher incidence of pelvic pain. [4]


Chronic pelvic pain is most common among reproductive-aged women. Common causes of chronic pelvic pain in men include chronic (nonbacterial) prostatitis, chronic orchalgia, and prostatodynia.


Chronic pelvic pain is most common among reproductive-aged women, especially those aged 26-30 years. [4]




As with other chronic pain, chronic pelvic pain may lead to prolonged suffering, marital and family problems, loss of employment or disability, and various adverse medical reactions from lifelong therapy.


Like other types of chronic pain, chronic pelvic pain may lead to prolonged suffering, marital or family problems, loss of employment, disability, and various adverse medical reactions from lifelong therapy.


Patient Education

The patient and the patient's family should have a good understanding about the multifactorial nature of chronic pain. They need multidisciplinary and comprehensive management plans.

Instruct the patient to avoid uncomfortable stressful positions and bad posture. Also recommend regular exercise, good sleeping habits, and balanced meals.

Try biofeedback and relaxation techniques.

For patient education resources, see Osteoporosis Center and Women's Health Center, as well as Chronic PainBladder Control ProblemsFemale Sexual ProblemsEndometriosis, and Pain During Intercourse.