Your Body is Telling You Something

There are a number of pelvic conditions specific to females that can cause symptoms and pain. Indications can be pelvic pain that is acute (sudden), chronic, intermittent, cyclic in nature or a non-painful feeling which interferes with daily life.

Crossed legs lounging on couch.

Problems with your pelvic floor may cause pain.

Age, childbirth, injuries and other issues can take their toll on a woman’s body. If you experience symptoms such as pelvic pain during sex, urination or bowel movements, or severe cramps in the pelvic area, or uncomfortable sensations that aren’t painful, we can help! Pelvic floor pain is a symptom that affects many women and can be caused by a wide variety of conditions and diseases. This discomfort can impact your everyday life and cause emotional issues.

Pelvic pain can be steady, or it can come and go. It can be a sharp and stabbing pain felt in a specific spot, or a dull pain that is spread out. It is best to contact your healthcare provider to share symptoms and concerns and ask questions or about new or chronic pelvic pain in order to get the best in diagnostics and treatment.

    What is Endometriosis?

    Endometriosis is a hormonal and immune disease affecting girls and women in their reproductive years. The name comes from the word, “endometrium,” which is the tissue that lines the inside of the uterus. This tissue builds up and sheds each month in the menstrual cycle.

    In women with endometriosis, tissue like the endometrium is also found outside of the uterus. These tissue “growths,” can cause pain, infertility and other problems.


    Woman’s physical therapists can help women deal with the pain caused by endometriosis. 

    • Manual therapy
    • Electrical stimulation for pain
    • Therapeutic exercises
    • Education on symptom management at home

    Removal of endometriosis lesions can be done by open abdominal surgery or by laparoscopy. Hysterectomy (removal of the uterus) may be considered when other treatments have failed.

    There are many different types of medications that your doctor may try to help decrease the endometriosis lesions or to treat the pain. Consult your doctor for more information on medications.

    Painful Intercourse

    Dyspareunia is the medical term for painful intercourse. Many women have painful sexual intercourse at some point in their lives. Women often describe it as a deep, throbbing pain, burning or aching. The cause of the pain is varied and depends on the person.

    Symptoms of Dyspareunia/Vaginismus can include:

    • Pain only with sexual penetration
    • Pain with every vaginal penetration, including putting in a tampon
    • Deep pain during thrusting
    • Throbbing pain that lasts hours after intercourse

    There are several reasons why intercourse might hurt. Possible causes can be divided into two categories.

    Pain at the vaginal entrance

    • Skin lesion: red area or sores
    • Vulvodynia: burning at the entrance to the vagina
    • Adhered scar: episiotomy or surgery scar that gets stuck
    • Small vaginal opening
    • Spasm of the superficial pelvic floor muscles.

    Pain deep in the vagina

    • Spasm of the pelvic floor muscles
    • Organ prolapse
    • Infection or irritation in the pelvic cavity
    • Abdominal adhesions, endometriosis, irritable bowel syndrome

    Treatments to Help Decrease Pain

    There are many treatments that can help. Here are a few:

    Medical treatments:

    • Topical creams to treat skin lesions
    • Medications to relax muscle spasm and relieve pain
    • Surgical procedures for skin lesions, organ prolapse and adhesions

    Therapeutic treatments:

    • Massage and stretching for scars and small vaginal size
    • Biofeedback or electrical stimulation for pelvic muscle spasm
    • Exercises and stretching for pelvic tension
    • Vaginal dilators to stretch the tissues

    What is Vulvodynia?

    Vulvodynia means pain in the vulva or the perineum. The vulva is the external female genitals. The perineum is the area between the vulva and the rectum, which includes the vagina, rectum, and inner thighs.

    • Cyclic Vestibulitis
      This is vaginal pain that comes and goes with your menstrual period. Some patients have increased pain with menstruation and some have decreased pain.
    • Vulvar Dermatitis
      These are skin conditions that cause pain in the perineum. These usually have visible spots of many different colors and types.
    • Idiopathic Vulvodynia
      The cause of this type is usually not known. This makes it very hard to diagnose and treat.

    What Causes Vulvodynia?

    The causes of Vulvodynia are varied. Sometimes it is not possible to identify the cause. Your doctor will be able to best tell which might be the cause in your case. Here is a list of possible causes:

    • Infection such as a sexually transmitted disease or yeast
    • Skin condition
    • Spasms of the pelvic floor muscles
    • Irritation of a nerve
    • Hormone imbalance
    • Injury
    • Chemical reaction or allergy Vulvodynia

    Treatments for Vulvodynia are as varied as the causes.

    It may take several tries to identify which will work best for you. It is best to give each treatment a six month trial before deciding that it is not helping (unless it is clearly increasing your pain). Always talk to your doctor and physical therapist before making changes in your treatment program.

    Determining Whether You Have Levator Ani Syndrome

    Levator Ani Syndrome results from spasm in the pelvic floor muscles. It is often caused by trauma in or around the pelvis, abdomen or back. Weak muscles can also spasm.

    There are no laboratory tests for this condition. Levator Ani Syndrome is a collection of symptoms and findings. Not all patients have all the symptoms. Only your doctor can diagnose Levator Ani Syndrome. The most common symptoms include:

    • Deep dull aching in the rectum/vagina
    • Referred pain to the thigh and buttock
    • Sensation of “sitting on a ball.” Pain is worse in sitting and with bowel movement.
    • Spasms and pain in the pelvic floor muscle
    • Pain during or after intercourse
    • Tests usually show there is no inflammatory bowel disease, infection, ulcers or other bowel problem.


    • Medications to decrease muscle spasm and pain.
    • Biofeedback to learn how to relax and contract the pelvic floor muscles properly.
    • Electrical stimulation to the pelvic floor muscles can relax these muscles and increase circulation and promote healing.
    • TENS (transcutaneous electrical nerve stimulation) electrical stimulation to the pelvic floor nerves in the lower spine may help to “cover up” the pain and to relax the muscles. 
    • Physical therapy to treat spasm in the buttock muscles or problems in the sacroiliac joint.
    • Heat and ultrasound can be used by physical therapists to relax the pelvic floor muscles.
    • A special form of rectal and buttock massage can be performed by the doctor or therapist to decrease pain and spasm.

    Polycystic ovary syndrome (PCOS) is a common condition that affects 10-15% of all women. It is currently the leading cause of infertility.

    Many women with PCOS also develop other health problems and are at risk for diabetes and heart disease. Early treatment can improve symptoms, fertility problems and lower the risk of heart disease and diabetes.

    Common Symptoms of PCOS include:

    • Irregular menstrual cycles
    • Acne
    • Excess hair growth (hirsutism) on the face, chest, abdomen or back
    • Scalp hair thinning
    • Oily skin and hair
    • Weight gain or obesity, especially in the abdominal area
    • Ovarian cysts
    • Depression
    • Infertility

    Varicose Veins of the Pelvis

    Pelvic congestion syndrome (PCS) is one of the causes of chronic pelvic pain, a condition very common in women. Approximately one third of all women will suffer from chronic pelvic pain at some point during their lifetime. 

    Pelvic congestion syndrome is caused by problems with the veins in the pelvic area. (This is the lower part of your belly or abdomen). In some women, blood can build up inside of these veins. As the veins enlarge and change shape, like varicose veins, it can lead to the pain and other symptoms of pelvic congestion syndrome. Hormones may also play a role as estrogen makes veins wider. 

    Who is at risk for pelvic congestion syndrome?

    You may have a higher risk for pelvic congestion syndrome if you have given birth to more than one child. You may also have a higher risk if other members of your family have it.

    What are common symptoms?

    • Pelvic pain that lasts at least 6 months.
    • Pain can start during or after a pregnancy. It may worsen after a later pregnancy.
    • Heavy or aching feeling, or sharp
    • Pain usually only on the left side. At times you may feel it on both sides. 
    • Pain is often worse at the end of the day.
    • Feeling a sudden need to urinate
    • Enlarged and distorted veins on the buttocks, external genitals (vulva), or thighs

    How is it treated?

    Your physician may suggest starting with medicines.

    • Gonadotropin-releasing hormone drugs (block ovarian function and relieve pain)
    • Progestin hormone drugs (relieve pain)

    If medications don't relieve your symptoms, a procedure may be advised to treat the condition.

    • Interventional radiology procedures to shut off damaged veins
    • Surgery to remove damaged veins
    • Surgery to remove your uterus and ovaries

    Pain, Pressure, Bleeding

    Fibroid pain and discomfort can change the way you act and live. Know the symptoms and talk to your OB-GYN about whether you might have fibroids. Don’t keep relief waiting.

    Fibroids are muscular tumors that grow in the wall of the uterus. They can affect your daily life causing heavy, excessive menstrual bleeding, pelvic pain and pressure, urinary incontinence and, in some cases, fertility complications.

    Types of Fibroids

    A woman can have many types of uterine fibroids. They are classified according to their location.

    Subserosal Fibroids: Develop on the outer uterine wall and put pressure on the surrounding organs. Symptoms include pelvic pain and pressure, not bleeding.

    Intramural Fibroids: The most common; can be mistaken for pregnancy or weight gain. Symptoms include excessive menstrual bleeding, pelvic pain, frequent urination and pressure.

    Submucosal Fibroids: The least common; develop under the lining of the uterine cavity and can block the fallopian tubes leading to fertility complications. Symptoms include very heavy, excessive menstrual bleeding and prolonged menstruation. 

    Pedunculated Fibroids: Grow on a stalk either into the cavity of the uterus or from the outside of the uterus into the pelvis. Symptoms include pain and pressure.

    Who is at Risk for Fibroids

    • 20-40% of women 35 years and older have fibroid tumors. 
    • More common among women of African-American descent.

    Treatment Options


    • Hormone Treatment: Medications that target hormones can reduce heavy menstrual bleeding and pelvic pressure. They don’t eliminate fibroids, but may shrink them.
    • Magnetic Resonance Guided Focused Ultrasound Surgery: High intensity ultrasound heat waves that cause the fibroid to die.

    Less Invasive

    • Uterine Fibroid Embolization (UFE)
    • Interventional Radiology (IR)
    • Endometrial Ablation: Destroying the endometrium (the lining of your uterus) to reduce your menstrual flow.


    • Myomectomy: Surgical removal of fibroids from the uterus.
    • Hysterectomy: Remove of the uterus.

    What is prolapse?

    Pelvic organ prolapse is a common problem that is often detected when women notice a bulge from the vagina when they wash or wipe after using the bathroom, or as they go about daily activities.

    Prolapse occurs when the pelvic floor muscles can no longer hold up the bladder, vagina, uterus and rectum, and they can “fall” outside the body. There can be weakness in just one area, such as just the bladder, or more.

    While prolapse usually isn’t painful, it can be very uncomfortable and can cause a feeling of pressure, which interferes with daily life. 

    Causes of prolapse

    Anyone can experience prolapse; however, genetics and risk factors may make a woman more prone to this condition, such as:

    • Women who had vaginal or forceps deliveries
    • A family history of prolapse
    • Obesity
    • Chronic constipation

    Treating prolapse

    The first place to start is with your primary care physician or OB-GYN.  There are many treatment options, including the following:

    Therapy: Woman’s offers specialized physical therapy to help strengthen the muscles that support the vagina, bladder and rectum.

    Vaginal Support: A pessary (vaginal insert) can be used to support the organs that have dropped. A pessary is not permanent and has to be removed periodically either by the patient or her doctor to be washed and then put back in. However, it can be used for years, and many women find this to be an excellent long-term solution.

    Surgery: There are many ways to surgically fix prolapse, but it depends upon the factors unique to your body and condition. Discuss options first with your OB-GYN, urologist or urogynecologist.

    Additional Interests

    • Woman looking from couch.

      Make a Plan for Relief

      Talk to us about therapy, including manual therapy, exercise prescriptions, biofeedback/electrical stimulation, education on how to manage your symptoms and medication management.

    • Sitting beside dog and looking up concerns on laptop.

      Check the Chart

      Don’t ignore your symptoms out of embarrassment. No one knows your body better than you. If you feel like something isn’t normal, pay attention. Make notes. And see your doctor.

    • Comfortable on teal couch wrapped in a blanket.

      Maybe Minimally Invasive

      With smaller incisions and shorter recovery time, we can diagnose and treat a variety of conditions, including abnormal vaginal bleeding, pelvic pain/pressure, and genital discomfort.