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1. When should I consult a health care professional about pelvic pain?

   You should make an appointment with your health care professional if your periods have become painful, you have vaginal bleeding at times other than during your normal menstrual cycle, you have pain during intercourse, urination, or bowel movements or you have blood in your urine or stool. If severe pelvic pain suddenly appears, you should see a health care professional immediately. Generally, a woman with pelvic pain and symptoms will see her primary care provider or gynecologist first. Depending on his or her findings, you may be referred to other specialists such as a urologist, for example, if there is a structural problem with your urinary tract. Ideally, you should be treated by a gynecologist who specializes in chronic pelvic pain. You may also require physical therapy.

2. What kinds of tests will I need for a diagnosis?

   Your health care professional will first conduct a medical history followed by a routine physical exam, including a pelvic and rectal exam, to locate your pain and find such potential problems as fibroids, masses and hernias. The specialist should also examine the muscles of the pelvic floor and hips. Your posture and gait may be examined to look for relations between those problems and your pain. Depending on those results, you may also be given standard blood tests, urinalysis and tests for sexually transmitted diseases. If your doctor suspects certain conditions, he or she may order an exploratory or diagnostic laparoscopy, pelvic ultrasound, or MRI.

3. Why can't I get complete pain relief?

   Complete relief from chronic pain, whether from chronic pelvic pain or other chronic conditions like backache, arthritis and fibromyalgia, can be difficult to achieve. No one medication works on all women with pain symptoms. A combination of medication, surgery, physical therapy, alternative therapies and lifestyle changes is often recommended to manage chronic pain symptoms.

4. Why did I get this disease? What causes it?

   Although there are risk factors that may have increased your chances for developing chronic pelvic pain, most are not things you could have prevented or controlled. The most common causes of chronic pelvic pain are: endometriosis, adenomyosis, PID, muscular problems, interstitial cystitis, irritable bowel syndrome and depression.

5. Why are my symptoms different from a friend's who also has chronic pelvic pain?

   Because of the wide range of conditions that can cause or contribute to chronic pelvic pain, symptoms vary from woman to woman. You may even notice that your own symptoms vary during your monthly cycle or over time. This variability adds to the difficulty in diagnosing the disease.

6. What can I expect from medical treatments?

   Your pain symptoms may not be totally relieved by taking medications. However, by working closely with your team of health care providers and using some self-care techniques, you may be able to reduce the impact your pain symptoms have on your lifestyle.

7. Should I have surgery? When should I consider surgery?

   The decision to have surgery is a personal one. In general, surgery to relieve pelvic pain is most successful only when the cause of the pain is structural, for example adhesions, ovarian cysts or an abnormality in the uterus, or when a disease like cancer is present and can be treated with surgery. For other conditions that cause chronic pelvic pain, surgical options may not be an option. In either case, surgery should be carefully discussed with your health care professional to determine risks, benefits and the chances that the surgery will relieve your pain symptoms.