What causes pelvic pain and how to treat it?

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Pain around the vagina, penis, anus, & buttock are often experienced by patients but seldom reported. Patients should know that this is a common problem that can often respond to comprehensive pain treatments by pelvic pain specialists.

Pelvic pain

Pelvic pain is experienced around the vagina, penis, scrotum, anus, & buttock. It can be worsened by sitting, standing, walking, sports activities, having bowel movements, urination, sexual arousal, sexual activities, & menstruation.

10 common sources of pelvic pain

The pelvic anatomy is complex. Below are 10 common sources of pain in the pelvic region:

  • Pudendal nerve: pain around the vagina, scrotum, anus
  • Hip joint: vague pain “around” the hip/pelvis
  • Coccyx: pain in the tailbone
  • Piriformis: pain in the buttock going down the thigh
  • Ilioinguinal nerve: pain in the groin
  • Obturator nerve: pain going down the inner thigh
  • Genitofemoral nerve: pain around the mons pubis, testicle, or scrotum
  • Obturator internus: “inner” buttock near the anus
  • Posterior femoral cutaneous nerve: pain along the back of the thigh
  • Referred visceral pain: via “viscerosomatic convergence” organ pain can manifest as diffuse pelvic pain.

Chronic pain cycle

Even if pain sources are identified, frequently pelvic pain involves the entire “chronic pain cycle”. Treatment requires comprehensive management including biomechanical & psychological treatments.


  • Physical examination
  • MR neurography
  • Diagnostic nerve blocks & muscle injections under ultrasound or fluoroscopy


  • Pelvic floor physical therapy
  • Biofeedback & relaxation techniques
  • Nerve blocks & radiofrequency ablation of the nerve endings can provide substantial relief lasting months
  • Peripheral nerve stimulation (PNS) or spinal cord stimulation (SCS) for convenient, non-drug treatment
  • Botox injection can reduce muscle tension & reduce neurogenic inflammation.
  • Visceral nerve blocks
  • Comprehensive pain management including complementary & alternative medicine (CAM)