Pelvic pain

Chronic pelvic pain.

Pain for more than six months usually has more than one source — gynecologic, muscular, bladder, bowel or nerve. A normal ultrasound rules out some of them and none of the rest.

How this is approached here

What the first visit covers

  1. 01

    A history that maps the pain to the cycle

    To the bladder, to the bowel and to intercourse — because which of those it tracks is what narrows the list.

  2. 02

    An examination that includes the pelvic floor muscles

    Myofascial pelvic pain is common, frequently missed, and does not show on imaging.

  3. 03

    Ultrasound the same day

    To look for endometriomas, adenomyosis, fibroids and hydrosalpinx.

  4. 04

    Urine studies and where the pattern fits, a bladder-focused assessment for interstitial cystitis rather than a fifth course of antibiotics.

  5. 05

    A written plan that names which cause is being treated first and what would change the plan — not a prescription and a six-month review.

What it is often not

Four things worth saying plainly

A normal scan is not a negative result

Endometriosis, adhesions and pelvic floor dysfunction are all invisible on ultrasound.

Diagnostic laparoscopy is not the first step

It is a reasonable step when medical management has failed and the history fits endometriosis.

Pelvic floor physical therapy is a treatment

Not a consolation prize. For myofascial pain it outperforms anything we can prescribe.

Being told the pain is stress does not make it stress

Central sensitisation is real, measurable and treatable, and is not the same statement.

Pelvic pain: common questions

How long will it take to get an answer?
Often more than one visit. Chronic pelvic pain with a single clean cause is the exception. What you should have after the first visit is a ranked list, a treatment started, and a date to reassess.
Do I need a laparoscopy?
Sometimes. It is the only way to confirm endometriosis, so if the history fits and medical treatment has not worked it is a reasonable step. It is not a first-line test, and a normal laparoscopy is a real possibility that should be discussed before you book it.
Will you just put me on the pill?
Continuous hormonal suppression is genuinely effective for cyclical pain and is often part of the plan. It is not the whole plan, and it is not offered as a way of ending the conversation.
I have seen four doctors already. Why would this be different?
The examination includes the pelvic floor and the bladder, the plan names what is being treated and what happens if it does not work, and you leave with it in writing. We cannot promise the pain resolves. We can promise you will not be told the scan was normal and left there.

Know before you book.

Vireo opens in 2027. Until then the plan list, panel status and first-available wait for every office are published on this site and kept current. Questions can go to the practice office on (305) 555-0180.

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