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Pelvic pain


Menstruation, mittelschmerz from ovulation, and food intolerance are commonly associated causes of pelvic pain. Women will most likely experience a sharp pain in the lower abdomen between the navel and groin. Apart from menstrual cramps, ovulation and gastrointestinal issues, pelvic pain could be a sign of a more severe condition linked to infectious diseases and infertility.

What is pelvic floor dysfunction?

The pelvic floor is classified as a group of ligaments and muscles in the pelvic region that supports organs of the pelvis-the bladder, rectum and uterus responsible for urination, bowel movements and sexual intercourse. Pelvic floor dysfunction forces the muscles to contract rather than relax, leading to bowel discomfort, colon damage and infection.

Pelvic floor pain, painful urination, constipation, pelvic muscle spasms, pelvic pressure, lower back pain and painful sexual intercourse are symptoms associated with pelvic floor dysfunction. Events such as childbirth and trauma to the pelvic region as well as conditions linked to obesity and nerve damage tear connective tissue and weaken the pelvic muscles leading to pelvic floor dysfunction.

Why is chronic pelvic pain associated with infertility?

Endometriosis is a common cause of chronic pelvic pain and infertility in women that occurs during menstruation when the tissue on the exterior of the uterus responding to hormonal changes leads to inflammation and bleeding of the pelvis.

What are the related symptoms?

Women with chronic pelvic pain will experience the following symptoms:

  • Fever/li>
  • Vaginal bleeding
  • Vaginal discharge with an unpleasant odour
  • Intense pelvic pain/li>

What causes pelvic pain?

Chronic pelvic pain can occur from connective tissue and muscles in the structures of the pelvic floor as well as pelvic nerve irritation. Chronic pelvic pain may arise from conditions affecting the female reproductive system such as adenomyosis and endometriosis. Further causes are intra-uterine foetal death before the twentieth week of pregnancy as well as menstrual cramps, Mittelschmerz, cysts, fibroids and pelvic inflammatory disease.

Adenomyosis results in mild discomfort as displaced endometrial tissue growing in the muscular wall of the uterus continue to thicken, break down and bleed during the menstrual cycle causing chronic pelvic pain from an enlarged uterus. Mittelschmerz, the German word for “middle pain” occurs halfway through the menstrual cycle causing sharp and sudden pelvic cramps accompanied by mild vaginal discharge or bleeding.

Small fluid-filled pockets called ovarian cysts are likely to grow in or on the surface of almond-shaped ovaries and can be severe if the cysts rupture. A large ovarian cyst causes dull or sharp chronic pelvic pain as well as heaviness in the abdomen resulting in bloating. Follicular and Corpus luteum cysts are classified as functional cysts and appear to be harmless, rarely causing chronic pelvic pain and often disappear after two menstrual cycles. Dermoid cysts that contain tissue of the hair, teeth or skin and mucoid-like cystadenomas can increase in size resulting in the displacement and painful twisting of the ovary, known as ovarian torsion leading to severe chronic pelvic pain.

Sexually transmitted bacteria can spread from the vagina to the uterus, fallopian tubes and ovaries, causing pelvic inflammatory disease (PID), an infection of the female reproductive organs. The signs of pelvic inflammatory disease are mild and subtle, and women might not realise they have a pelvic infection until symptoms of chronic pelvic pain, painful urination, fever and bleeding between menstrual cycles start to occur.

How is pelvic pain diagnosed?

Diagnosis of pelvic pain depends on your prior health conditions. Imaging tests such as magnetic resonance imaging (MRI) and abdominal X-rays pick up any unusual growths such as polyps or fibroids, leading to pelvic pain. During a pelvic exam, Dr Benecke will check for tender areas to reveal signs of dysfunctional pelvic floor muscles or infections. Laboratory tests will detect STDs such as chlamydia or gonorrhoea and analyse blood cell counts and urinalysis diagnosing urinary tract infections associated with chronic pelvic pain.

How is pelvic pain treated?

At the Endometriosis Clinic, our interdisciplinary team of professionals along with Dr Benecke will treat this debilitating condition affecting all spheres of life utilising various medical treatments and psychological approaches.

Dr Benecke may prescribe oral contraceptives to inhibit ovulation and prevent mid-cycle chronic pelvic pain. Our bowel surgeons at the Endometriosis Clinic treat the prolapse of the bladder, uterus, vagina, small bowel and rectum from pelvic floor dysfunction through resection.

Specialised Services

While Dr Benecke is a gynaecologist & obstetrician offering the full range of women's health services, his niche lies in the treatment and management of the following gynaecological conditions:


Due to the complexity of the diagnosis, Dr Benecke is meticulous during each consultation and using a multidisciplinary approach he can provide highly specialised treatment and management of this condition as well as the related symptoms such as chronic pelvic pain and the complication of infertility.



Sharing similar symptoms to that of endometriosis, fibroids are growths that develop on the uterus. The size of fibroids can range, growing from the size of a pea to the size of a watermelon, distorting the uterus and causing disabling symptoms.



Polycystic ovary syndrome (PCOS) is a hormonal disorder that disrupts oestrogen production and causes an imbalance of the male hormones, androgens. PCOS causes disruption of the menstrual cycle leading to complications such as severe abnormal uterine bleeding, the development of numerous fluid-filled cysts in the ovaries and infertility.