Pelvic Pain

Dr Jenny Cook  |  Sydney Gynaecologist & Advanced Laparoscopic Surgeon

Finding the Cause

I see many women with chronic pelvic pain. The most common reason is endometriosis. Other causes for chronic pelvic pain include a history of Pelvic Inflammatory Disease (PID) — this may follow an infection with Chlamydia or Gonorrhoea. Some women have adhesions (following previous surgery). Interstitial cystitis (inflamed bladder) is a recognised cause of chronic pelvic pain.
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Pelvic pain is common but never normal. You deserve answers and permanent relief from pain.
Causes

Pelvic Congestion Syndrome

Pelvic Congestion Syndrome is a cause of chronic pelvic pain characterised by worsening pain on sitting or standing for a long time, often relieved on lying flat. The pain can be worse following menstrual periods or intercourse.

Pelvic congestion is due to incompetent valves in pelvic veins, leading to backflow of blood that pools within the pelvis. The pressure results in pelvic pain. Pelvic congestion can be suspected on an ultrasound (USS) with dopplers to examine the blood flow.

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Treatment

Laparoscopy

A laparoscopy is performed to diagnose and treat the underlying cause of pelvic pain.

  • Endometriosis is definitely excised.

  • PID will be obvious if there are filmy adhesions and dilated Fallopian tubes (hydrosalpinx). A hydrosalpinx is a well-recognised cause of pelvic pain. We will have a careful and detailed discussion regarding the role for removing the hydrosalpinx to address the pain (salpingectomy).

  • Adhesions refer to areas of scar tissue — often involving the bowel and other pelvic organs. These are carefully divided.

  • Pelvic congestion can be diagnosed when there are persistently dilated pelvic vessels which do not empty despite changes in position.

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Some women have ongoing pain following a laparoscopy. This may be due to neuropathic (nerve-related) pain. There can also be pelvic floor muscle spasm. This can be effectively addressed by a pelvic floor physiotherapist. In some situations, referral to a chronic pain clinic is required.

Case Studies

Don’t live with chronic pelvic pain.

With the right investigations, treatments, and support, pelvic pain can be effectively managed. I will work with you to find the underlying cause and provide a tailored treatment plan to help restore comfort and quality of life.

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