Pelvic pain refers to discomfort felt in the lower abdomen and groin area that can vary in intensity and duration. Because it may originate from gynecologic, urinary, gastrointestinal, musculoskeletal or nerve-related problems, a careful history, focused physical exam and selected tests guide further assessment and referral.
Pain may be sudden or gradual, constant or intermittent, short-lived or persistent. Important features include timing (hours, days, months), relation to the menstrual cycle, connection with urination or bowel movements, and any vaginal discharge or bleeding. These details help clinicians narrow which organ systems to consider.
Pelvic pain often has multiple potential sources. Gynecologic causes can include ovarian cysts, endometriosis, adnexal problems or pelvic inflammatory disease. Urinary causes include urinary tract infection or kidney/ureteral stones. Gastrointestinal causes may involve irritable bowel, diverticular disease or inflammatory bowel conditions. Musculoskeletal and pelvic floor issues, nerve irritation and psychological factors can also influence pain perception.
Evaluation typically begins with history and physical examination. Initial tests may include urine analysis, pregnancy test when relevant, blood tests for infection markers, and swabs if an infection is suspected. Pelvic ultrasound, including transvaginal ultrasound when appropriate, is a common imaging choice; CT or MRI may be used for further evaluation. Results guide whether care is managed in primary care or by a specialist.
Seek immediate medical attention if pain is sudden and severe, accompanied by high fever, fainting or severe dizziness, heavy vaginal bleeding or signs of shock. For non-urgent but persistent or recurrent pain, start with your primary care clinician who can refer you to gynecology, urology, gastroenterology, physical therapy or pain management depending on findings.
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