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.

Women with chronic pelvic pain will experience the following symptoms:

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

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.

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.

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.