The treatment of pelvic pain obviously depends on the cause of the pain. We must remember that our purpose must be to 1) treat any and all life-threatening medical emergencies and then 2) eliminate the suffering experienced by women with chronic pain. Acute pain in the pelvis requires immediate evaluation by a health care provider to identify the cause. It is interesting that some women experience repeated episodes of acute pain. This is often attributed to "ruptured cysts" on the ovaries, however, abdominal wall muscle spasms or functional problems with the bowel are more likely the cause in most cases. Proper treatment obviously requires proper diagnosis.

Treatment of pelvic pain, whether acute or chronic, requires a trusting relationship with a skilled health care provider. It is not therapeutic to receive care by making repeated trips to the emergency room. That situation is designed only to diagnose and treat medically urgent conditions. Once such a condition has been ruled out, the providers have no commitment to finding and treating the cause of the pain. Their response is to treat women with narcotics so we can leave the ER, then send us to someone else for follow-up care. Unfortunately, by the time the follow-up physician is seen, the pain may well have resolved. We strongly recommend that women who suffer from pelvic pain establish a working relationship with a caring and accessible physician. Only someone who has had the luxury of taking a full and complete physical, social, and family history can evaluate a patient properly. These things cannot happen in the bustle of the emergency room.

Treatment of chronic pain is best accomplished in a multi-disciplinary setting. A skilled gynecologic surgeon may be necessary to treat severe endometriosis or significantly enlarged fibroids, however, the body's response to chronic pain must be addressed by physical therapists and psychologists if we are to be truly successful in managing the pain on a long-term basis. Women with chronic pelvic pain almost universally also suffer from depression (who wouldn't be when they are in pain all the time?) which increases their perception of pain. In addition, for many women, the pelvic floor muscles have become chronically tense protecting the pelvis from jarring and increased pain. That muscle tension in and of itself may become the overwhelming source of pain. Physical therapists specifically trained in the evaluation and management of pelvic floor disorders can be amazingly helpful. Many conditions such as adhesions or severe endometriosis may never be totally "cured" surgically. Nevertheless, the pain associated with them can be almost completely resolved with careful, comprehensive, multi-disciplinary care.

Disorders of the abdominal wall or pelvic floor are often managed with physical therapy. In addition, sometimes nerves can become trapped in abdominal wall scars creating severing burning, searing pelvic pain. These nerves can be injected with a combination of local anesthetics and steroids with dramatic improvement in pain. Once again, the key to the successful treatment of pelvic pain is accurate diagnosis and a trusting, therapeutic relationship with a health care provider who will listen and continue to pursue strategies for management until quality of life has been restored.