If you’ve ever been told your pelvic pain is “just stress” or something you need to learn to live with, you’re not alone. Around the world, women with chronic pelvic pain face long delays in diagnosis, limited treatment options, and the burden of not being believed. But here’s the truth: pelvic pain is real, complex, and treatable with the right support.
I’m Alex Frankham, a Clinical Specialist Physiotherapist in Persistent Pelvic Pain, Director of Physio.je in Jersey, educator for the Pelvic, Obstetric and Gynaecological Physiotherapy (POGP) professional network, and a member of both the International Pelvic Pain Society (IPPS) and the Institute of Psychosexual Medicine (IPM). Over the years, I’ve worked with many living with pelvic floor dysfunction, bladder pain, endometriosis, post-surgical pain, and unexplained pelvic pain.
This blog is for you: to help you understand why pelvic pain is not “all in your head,” why it’s often misunderstood, and what steps you can take today.
Why Pelvic Pain Is Often Misunderstood
Despite being common, pelvic pain in women remains a highly under-recognized health challenge worldwide. Research shows pelvic pain is often overlooked even in medical education the FIGO–IPPS consensus statement highlights the global unmet needs of women with chronic pelvic pain, pointing out major gaps in diagnosis, treatment, and support leaving clinicians underprepared to help. The result? Too many women are dismissed, told their symptoms are “in their head,” or passed between specialists without answers.
What Causes Pelvic Pain?
Pelvic pain is not caused by one thing — it’s usually an interplay of factors, again another reason why people and clinicians cannot give one solution, or that every person has the same problem and same recipe to help them. Pelvic pain could be caused by specific medical conditions such as:
- Gynaecological conditions of endometriosis, adenomyosis, or post-surgical adhesions
- Bladder and bowel conditions such as interstitial cystitis, irritable bowel syndrome
- Pelvic floor dysfunction, where the muscles are not functioning at their best and may be overly reactive
- Neuro-immune system sensitivity, this is complicated but essentially pain pathways can become overactive, amplifying discomfort – the body is more sensitive – like a fire alarm going off and calling the fire brigade just because you made toast in the toaster!
- Hormonal and inflammatory influences - cyclical pain which may be linked to menstruation or inflammation and can overtime perpetuate more inflammation
- Emotional and social context – this is not saying “it’s in your head” but there is empirical evidence that stress, trauma, or not being believed can worsen pain perception
The important thing is that pelvic pain is real. It is not “all in your head.” Instead, it is a whole-body experience where both body and brain play a role.
What Helps: Evidence-Based Approaches
The EAU Guidelines on Chronic Pelvic Pain recommend a multidisciplinary approach — meaning the best results often come from a combination of strategies.
1. Medical Specialists
To help with specific pharmacology (not all medicines help), ensuring the most appropriate investigations (MRI, USS, blood tests) have been undertaken, and undertaking relevant surgery following detailed investigations.
2. Specialist Physiotherapy
Pelvic health physiotherapists can help with muscle tension, posture, breathing, and safe, guided movement and pacing, instead of “boom and bust” (doing too much on good days, then crashing), pacing activities builds confidence and resilience. Yoga, Pilates, or tailored exercise can help.
3. Pain Education
Learning about how the nervous system processes pain can change how you respond to flare-ups, reducing fear and anxiety.
4. Multidisciplinary Support
This may include gynaecologists, urologists, dietitians, psychologists, pain specialists, psychosexual therapists working together.
5. Emotional Support and Self-Compassion
Living with pelvic pain is tough. Recognising the emotional toll and seeking support is part of healing.
Finding Hope with Pelvic Pain
Pelvic pain may feel overwhelming, but you are not alone. With the right care, many women find ways to reduce pain, improve quality of life, and feel more at home in their bodies again.
At Physio.je in Jersey, I work with women experiencing pelvic floor dysfunction and chronic pelvic pain. Through my work with POGP and IPPS, I’m passionate about bridging the gap between science and support, so women everywhere feel heard and helped.
If you’re struggling for support or being believed, explore trusted resources like the EAU Chronic Pelvic Pain Guidelines; the ESHRE Guideline Endometriosis; and if you are in the UK it is most likely that your healthcare providers will be familiar with and following the National Institute of Clinical Excellence Guidelines (NICE). NICE is the UK’s health body that reviews the best research and sets clear guidelines on what safe, effective care should look like.
References
Coxon, L., Horne, A.W. and Vincent, K., 2022. Identifying gaps in pelvic pain education: A scoping review and structured analysis of obstetrics and gynecology training milestones. American Journal of Obstetrics and Gynecology, 227(3), pp.440–448.
EAU, 2025. EAU Guidelines on Chronic Pelvic Pain. European Association of Urology. Available at: https://uroweb.org/guidelines/chronic-pelvic-pain [Accessed 6 September 2025].
ESHRE, 2022. ESHRE guideline: endometriosis. European Society of Human Reproduction and Embryology. Available at: https://www.eshre.eu/guideline/endometriosis [Accessed 6 September 2025].
FIGO & IPPS, 2021. Addressing the global unmet needs of women with chronic pelvic pain. International Journal of Gynecology & Obstetrics, 155(1), pp.1–6.
NICE, 2025. Endometriosis: diagnosis and management. National Institute for Health and Care Excellence. Available at: https://www.nice.org.uk/guidance/ng73 [Accessed 6 September 2025].
