Some people find their pain gets better without treatment. Others need to work at reducing their pain over time. Everyone is different and there is no ‘one way’ to manage persistent (chronic) pelvic pain (PPP).
It’s a complex process to diagnose persistent pelvic pain. Depending on your symptoms, your doctor may refer you to different healthcare professionals (e.g. gynaecologist, pain specialist, physiotherapist, psychologist). If other obvious causes of pain are not found, your healthcare team may diagnose chronic pelvic pain syndrome. This process can take time.
See your doctor
A person-centred approach
Your healthcare team
Medicine to help manage your pain
How long will it take to reduce your pelvic pain?
Book a long appointment with your doctor so you have lots of time to talk about your pain. You can also bring a support person to your appointment if you need one.
It's important to give your doctor as much information about your pain as possible. This will help them to investigate potential causes.
It’s a good idea to bring:
Your doctor may ask a range of questions about your pain and how it affects your life. For example:
They may also ask:
Your doctor may ask to do a thorough physical examination. If you feel uncomfortable or don’t want this, it’s okay to say no. If you have an examination, your doctor may check:
You may also need to have some tests and procedures such as:
These tests will check for any obvious causes of your pain.
It’s important to ask questions and learn as much as possible about your persistent pelvic pain. These questions may also help you find the best doctor to treat your pain.
You can ask:
You can also ask:
Persistent pelvic pain is a complex condition that’s influenced by biological, psychological and social factors. That’s why a person-centred approach is needed to develop an effective treatment plan. This means you are at the centre of treatment and your needs and experiences are taken into account. The plan should focus on managing symptoms that bother you.
Your treatment plan may include one or more of the following:
The best approach to managing persistent pelvic pain involves working with a healthcare team (i.e. a multidisciplinary approach). But it can be hard to access health practitioners in some locations (e.g. regional and remote areas). Talk to your doctor about available supports via face-to-face or Telehealth appointments.
Depending on your situation, you might see different healthcare professionals.
Your doctor will provide most of your care and will start your treatment. They will refer you to specialists and coordinate care with the rest of your healthcare team. They will also continue to manage your overall health.
Pain specialists are medical doctors with advanced training in pain management. They understand the complex nature of pain and use a range of approaches that can help you reduce your pain.
Pelvic floor physiotherapy is widely used to manage persistent pelvic pain. Pelvic floor physiotherapists have extra training and special skills in women’s health. They can help improve the function of your pelvic floor, abdominal muscles, back and hips, and help you learn how to move and exercise in a way that is right for you. They can also explain basic pain-relief techniques and help you learn about pain, which is an important part of managing pain.
Psychologists may use a range of techniques, including cognitive behavioural therapy (CBT) and acceptance and commitment therapy (ACT) to help you manage your pain. They can help you understand the link between your thoughts, emotions, physical sensations, behaviours and pain. They may focus on thoughts and feelings, and different coping strategies to help manage your pain. Psychologists can also help with anxiety and depression, which are common in people with persistent pelvic pain.
Sex therapists can help you to understand how persistent pelvic pain might cause painful sex. Past experiences of painful sex may cause you to fear pain. This fear can create stress, tension and reduced sex drive and arousal. If sexual difficulties cause problems for you, it may help to discuss your feelings with a sex therapist or relationship counsellor.
Dietitians can help you identify food that might trigger a pain flare. They can also recommend a balanced diet to help reduce your pain.
Naturopaths can provide complementary ways to manage your pain. These may include supplements, herbal medicine, acupuncture and lifestyle changes. Many women use these therapies to manage their health, but there is limited evidence to support their safe and effective use. If you’re using complementary ways to manage your pain, it’s important to discuss the risks and benefits with your doctor.
Urogynaecologists are specialists in pelvic health. They can diagnose and treat bladder and pelvic floor problems that may contribute to pelvic pain.
Gastroenterologists specialise in conditions that affect the digestive system. They can diagnose and treat digestive conditions that may be contributing to your pain.
Sleep specialists are doctors who diagnose and treat sleep disorders. They can help with medicines and sleep routines to improve the quality of your sleep.
Exercise physiologists give people information and advice about exercise to help manage and prevent injuries and chronic conditions. They develop individual exercise programs, provide counselling on how to maintain an active lifestyle and make sure exercise programs are safe and effective.
Medicine may be used to help manage persistent pelvic pain. While this can be useful for some people, it should only form part of your overall treatment plan.
Your healthcare team may recommend short-term pain-relief medicine, for example, paracetamol, and nonsteroidal anti-inflammatory drugs (NSAIDs), for example, ibuprofen or naproxen. These may be useful for certain types of persistent pelvic pain (e.g. period pain).
They may also suggest medicines that target nerve pain, or hormone therapies (e.g. the oral contraceptive pill, an intrauterine device (IUD) or injections).
Opioids (strong pain-relief drugs) are not recommended for persistent pelvic pain as they can make the pain worse and might lead to dependency with regular use.
It may take time and many different approaches to reduce your pelvic pain. It can take three to six months for your treatment to start working. During this time, it’s important to be patient and follow your plan, even if you don’t notice any difference straight away.
Successful treatment may not mean you will be pain free in the future. But it may help you to manage your pain so it doesn’t interfere with your daily life.
This web page is designed to be informative and educational. It is not intended to provide specific medical advice or replace advice from your health practitioner. The information above is based on current medical knowledge, evidence and practice as at May 2023.
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