Pelvic Pain: Causes by System & When to Seek Care

Pelvic pain has diverse origins across organ systems. A systematic approach guides diagnosis.

1. Gynecologic (Most Common in Women)

• Endometriosis (cyclic, deep dyspareunia)
• Adenomyosis (heavy, painful periods)
• Ovarian cysts (rupture, torsion)
• Fibroids (bulk, pressure)
• PID (STI-related, fever, discharge)
• Ectopic pregnancy (emergency)
• Menstrual cramps (primary dysmenorrhea)

2. Urologic

• UTI (dysuria, frequency)
• Interstitial cystitis/bladder pain syndrome
• Kidney stones (colicky flank→groin)

3. Gastrointestinal

• IBS (bloating, altered bowel habits)
• Constipation, diverticulitis (LLQ)
• Appendicitis (RLQ, migratory)
• IBD (Crohn's, UC)

4. Musculoskeletal

• Pelvic floor dysfunction (hypertonic → pain, dyspareunia, urinary urgency)
• Sacroiliac joint dysfunction
• Pubic symphysis diastasis (pregnancy/postpartum)
• Hip pathology (labral tear, FAI)

5. Vascular/Neurologic/Other

• Pelvic congestion syndrome (varicose veins)
• Pudendal neuralgia
• Hernias (inguinal, femoral)
• Malignancy (ovarian, uterine, colorectal, bladder)

Red Flags (Urgent Evaluation)

• Pregnancy + pain/bleeding
• Fever + pelvic pain
• Hemodynamic instability
• Mass on exam

Start with primary care or OB/GYN. Multidisciplinary often needed.