causes of pelvic pain in women

Your pelvic area is the area between your hip bones, below your stomach and above your thighs – near your bladder and lower back.

For women, this includes your:

• uterine cervix.

• Fallopian tube.

• Ovary.

• Womb.

• Vagina.

Dr Leia Rispoli, interventional pain management specialist and physiatrist at DISC Sports & Spine Centre, California, USA, explains that it is important to understand the exact location of your pelvic area to identify the source of your pain.

She says: “Being able to narrow down a diagnosis will depend on where you’re feeling the sudden, sharp pain, which makes a big difference.”

Denise Urtert, a nurse practitioner and pelvic pain specialist based in Los Angeles, US, says it can be challenging to pinpoint exactly where your pelvic pain is coming from.

“Pelvic pain can come from a variety of sources, including the reproductive, gastrointestinal or urinary systems,” she says. “However, certain patterns and symptoms can help narrow it down to a possible cause.”

pelvic pain in women

Pelvic pain is generally more common in women, mainly due to the presence of reproductive organs in the pelvic area.

Some common gynecological causes of pelvic pain include:

• period pain – Starts before or during your menstruation. May be sharp, dull or crampy and may spread to your back and thighs.

• ovarian cysts – When a cyst on your ovary grows larger, twists, or ruptures. There may be a dull, heavy feeling or sudden, severe and sharp pain.

• endometriosis – Where the womb lining cells develop outside the uterus. Causes severe pelvic and period pain.

• Pelvic Inflammatory Disease (PID) – Infections in your reproductive organs, such as the fallopian tubes, ovaries, and uterus. This can cause painful periods, pain in your pelvis, and discomfort during sex.

In rare cases, pelvic pain may be a symptom of ectopic pregnancy when a fertilized egg develops outside the uterus, usually in one of the fallopian tubes.

gastrointestinal causes

Because the conditions of your intestine and reproductive organs overlap, it can sometimes be difficult to determine whether symptoms are related to gynecological or digestive (gastrointestinal) pain.

Dr Janet Choi is a reproductive endocrinologist based in New York, USA.

She says: “Pain above the navel (upper abdomen) is more likely to be gastrointestinal, although this is not always true. Pain below the navel can also be caused by gastrointestinal causes.”

Air trapped in your intestines can also cause sudden, sharp pain in your pelvic area, says Uttert.

urinary conditions

Sometimes pelvic pain is caused by a urinary tract infection (UTI). These can affect any part of your urinary system, such as the kidneys, bladder, and urethra.

Urarte says: “Although usually associated with a burning sensation, some UTIs can cause severe pain in the pelvic area, especially if the infection spreads to your kidneys.”

musculoskeletal issues

Pain in your pelvis may be caused by problems with your muscles or bones.

“Examples of this include pelvic floor dysfunction,” says Urtert. “Muscle spasms or pelvic floor strain can cause sharp, stabbing pain, especially after physical activity.

“Pudendal neuralgia – a condition caused by damage to the pudendal nerve – which can cause stabbing or burning sensations in the pelvic area.”

Stress – both past and present – ​​can cause pelvic pain in some women without any detectable physical problem in their pelvic organs.

David D. Clark, president of the Psychophysiological Disorders Association, explains that it may be the long-term effects of current life stress, undiagnosed anxiety, depression, post-traumatic stress (PTSD), or an adverse situation in childhood.

Urtert says chronic stress and anxiety can lead to muscle tension — especially in your pelvic area — which can worsen conditions like IBS or pelvic floor dysfunction.

“Learning stress reduction techniques like mindfulness or meditation can help manage this type of pain,” she says. “If you need additional guidance, talk to your doctor or consult a licensed therapist to discuss next steps.”

Along with stress, lifestyle factors such as diet and exercise can either contribute to or worsen pelvic pain.

Urtert says the foods you eat can affect conditions like IBS, endometriosis or UTIs. A diet rich in processed foods and sugar can increase inflammation and worsen symptoms.

“Eating a fiber-rich diet and staying hydrated can improve bowel health and potentially reduce pelvic pain,” she says. “Regular physical activity also improves circulation and releases endorphins, which can help with pain management.”

She says specific pelvic floor exercises — such as Kegels — can strengthen the muscles and reduce discomfort caused by muscle tension or spasms.

Low-impact exercises such as yoga, walking or swimming may also be beneficial.

Although most pelvic pain is not a medical emergency, some conditions require immediate attention. For example, appendicitis, peritonitis, and kidney stones – along with some of the possible causes listed above – can all cause severe pelvic pain.

“Seek medical help to ensure proper diagnosis and treatment,” says Urtert. “Understanding your body and recognizing when something feels off is key to getting the care you need.

“Whether lifestyle changes, medication, or surgical intervention, there are options available to help you find relief from pelvic pain.”