Common Causes of Pelvic Pain in Women — and When to Seek Pelvic Floor PT

Written By Kelley Warner, PT, DPT, OCS

In Atlanta and Denver, many women live with pelvic discomfort that’s treatable with the right plan. This guide explains common causes, how pelvic floor PT helps, and when to seek care (or see your physician first).

**Educational only; not medical advice.

How common is pelvic pain?

Pelvic pain is common—about 1 in 7 U.S. women of reproductive age report pain lasting six months or more [1]. The American College of Obstetricians and Gynecologists defines chronic pelvic pain as pain persisting ≥ 6 months and recommends an individualized, multimodal plan of care. Because high-quality studies are limited, many management strategies are adapted from research on other chronic pain conditions.

Common causes (often overlapping)

  • Endometriosis & dysmenorrhea. Tissue outside the uterus can drive cyclic or non-cyclic pain; pelvic floor overactivity from guarding is common. ACOG supports an individualized, multimodal approach to chronic pelvic pain management [2]

  • Pelvic floor myofascial pain/hypertonicity. Overactive or tender pelvic floor muscles can refer pain to the vagina, vulva, tailbone, hips, or lower abdomen; often worsened by sitting or penetration [2]. A 2024 systematic review found multimodal physical therapy effective for women with chronic pelvic pain [3]

  • Pain with sex (dyspareunia), vaginismus, vestibulodynia. Contributors include tissue sensitivity, hormonal changes, and pelvic floor hypertonicity [2]. An RCT of pelvic floor rehabilitation showed significant reductions in dyspareunia pain and improved function [4]

Woman lying on a bed holding her lower abdomen, showing pelvic pain

  • Bladder pain syndrome / interstitial cystitis (BPS/IC). Frequently coexists with pelvic myofascial tenderness; major guidelines recommend mechanism-based, multidisciplinary care [5]

  • Postpartum pelvic girdle pain (PGP). Load-transfer changes across the pelvis/abdominal wall can persist postpartum; professional guidance supports evidence-based PT evaluation and care pathways [6]

  • Bowel contributors (IBS/constipation). Visceral hypersensitivity and pelvic floor coordination issues (e.g., straining) can amplify pelvic pain; evaluation should consider overlapping systems [7]

Woman learning diaphragmatic breathing with pelvic floor physical therapist in Atlanta clinic

What pelvic floor PT actually looks like

  • Education & calming the system — pain science, pacing, sleep/supportive routines (aligned with chronic pain best practice) [8]

  • Breathwork & down-training: reduce guarding; ribcage-pelvic floor coordination

  • Manual therapy (external/internal as appropriate): trigger points, scar mobility, pelvic mechanics, dry needling

  • Graded movement & strength: hips/core/thorax coordination

  • Bladder & bowel strategies: urge suppression, voiding/defecation mechanics, fiber/fluids coaching (with your provider)

  • Sexual function support: gradual desensitization, dilator programs, partner education—often with gynecology/sex therapy

When to seek pelvic floor PT (and when to see a physician first)

See a medical provider urgently for:

  • Fever

  • Unexplained vaginal bleeding

  • Severe or rapidly worsening pain

  • New pelvic pain in pregnancy

  • Suspected infection or foul-smelling discharge

  • Other red-flag symptoms per AAFP [9]

PT may help if you notice:

  • Painful sex (dyspareunia)

  • Pain with tampon insertion or attempts to insert a tampon

  • Pain during a pelvic exam

  • Pelvic, vaginal, vulvar, tailbone, or low-abdomen pain lasting > 6 weeks

  • Urinary urgency or frequency

  • Postpartum pelvic girdle pain

  • Constipation or straining

  • Pelvic pressure/heaviness (possible prolapse)

  • Leakage with cough/sneeze/exercise (stress urinary incontinence)

What to expect at Revelle

Pelvic floor physical therapist speaking with a patient during an exam

We pride ourselves on truly individualized, trauma-informed care. Your goals drive the plan, and we meet you exactly where you are—explaining every step and coordinating with your medical team when needed. Here’s what a typical first visit at Revelle looks like:

  • History & goals: pregnancy/birth details, pain or leakage patterns, bowel/bladder habits, activity demands, and what you want to get back to

  • Movement screen: posture, breathing, core/hip strength and coordination, plus functional tasks (squat, lift, walk/run form)

  • Pelvic floor exam (consent-based): external and/or internal assessment of muscle tone, strength, coordination, scar mobility, and tenderness—only if you choose

  • Trauma-informed care: you can pause or decline any part at any time; we explain every step, and a chaperone is available upon request

  • Your plan: individualized exercises, breathing/pressure-management strategies, manual therapy or scar work as appropriate, pacing, and return-to-activity guidance

  • Team approach: we coordinate with your OB/GYN, urogynecologist, PCP, or other specialists when imaging, labs, or consults are indicated

  • Follow-up cadence: typically every 1–2 weeks to start, then adjusted as you meet milestones

  • What to bring/wear: comfortable clothes you can move in; any relevant reports (birth notes, imaging); and your questions

Have questions? Get a free 15-minute phone consult!

Same-week spots often available.

FAQs

  • Pelvic pain isn’t just “normal”—it’s common and treatable. If it’s lasting > 6 weeks or affecting your daily life, pelvic floor PT can help. If you have fever, new pain in pregnancy, or heavy/unexpected bleeding, see a medical provider first.

  • No. Exams are consent-based. We can begin with external assessment and a gentle plan; you can pause or decline any part at any time.

  • Many people notice change within 3–6 visits (usually over 4–8 weeks), depending on the drivers of your pain and how long symptoms have been present.

  • Absolutely. While pelvic floor PT doesn’t treat endometrial tissue itself, it can address pain drivers associated with endometriosis—like pelvic floor overactivity, myofascial tenderness, guarding, bladder/bowel symptoms, and pain with activity or sex—so you can move, sleep, and function better. We typically work as part of a multimodal plan alongside your physician. For a deeper dive, see our guide: Endometriosis & Pelvic Floor Physical Therapy.

  • We address urge strategies, voiding/defecation mechanics, and pelvic floor coordination. We also collaborate with your medical team when specialty care is needed.

  • Yes—telehealth is available for education, coaching, and exercise progressions when appropriate. That said, in-person care is extremely valuable for hands-on assessment and treatment, which often delivers the most meaningful results. We’ll let you know when in-person visits are recommended and help you choose the best mix for your goals.

Kelley Warner, PT, DPT, OCS
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