Stop Pushing Through Pelvic Pain — Expert Advice On Seeking Help

As a board-certified gynecologist, minimally invasive gynecologic surgeon, and expert in pelvic pain, I hear versions of this story every single day in my practice: a patient has been dealing with debilitating pain for years—perhaps horrible periods, or pain with sex. 

Her mother, her sister, her friends all had the same thing, so she assumed it was just something that all women had to deal with. She may have even asked other gynecologists about these problems, and was told that everything was “normal”, so she grit her teeth and tried to push through. This is never acceptable, and no one should have to simply suffer.   

But just because it's common does not mean it's normal.

My litmus test

Some cramping during your period is expected. Manageable discomfort (the kind ibuprofen and a heating pad can handle) isn't cause for alarm. 

I always ask my patients a few pointed questions:

Endometriosis, one of the most common causes of severe period pain, frequently comes with bowel symptoms that get misdiagnosed as irritable bowel syndrome, like significant constipation, pain with bowel movements, diarrhea, and bloating severe enough that people look pregnant—what's sometimes called "endo belly."

Painful sex gets normalized the same way. Some initial discomfort is common when you're newly sexually active, postpartum, or navigating perimenopause or menopause, and it's usually something that improves with time, lubrication, or vaginal estrogen when needed. But sex that's excruciating, or pain that starts spreading beyond intercourse to things like running or standing, is telling you something else is going on, whether that's endometriosis, a pelvic floor issue, or a hormonal change that needs treating, not just tolerating.

My book is called It's Not Hysteria because so many of these things get written off as "you're just anxious," when they're actually medical conditions we can treat. If something's really affecting you and keeping you from living the life you want to live, there is almost always something we can do to fix it.

Why the research hasn't caught up

Part of why we're still here comes down to history. The word hysteria comes from the Greek word for uterus. For centuries, women's ailments, physical or psychological, got blamed on a wandering womb. That framing never fully left. It shows up today as a research gap: endometriosis affects at least 10% of women, fibroids affect 70 to 80%, and we still don't know what causes either one. 

Fibroids can make you hemorrhage to the point of an ER transfusion, grow to the size of a watermelon, affect your fertility. If 80% of men had something that made them hemorrhage through their penis for a quarter of their life, I don't think we'd accept not knowing why!

Without knowing the cause, treatment tends to focus on managing symptoms rather than preventing or curing the condition. And that gap shows up in how long people wait for answers. On average, it’s seven years in the US, eight in the UK, to get an endometriosis diagnosis. That's not acceptable. We need to figure it out sooner.

The specialists most people don't know about

Two resources I think are seriously underused: pelvic floor physical therapy, and my own subspecialty, minimally invasive gynecologic surgery, or MIGS.

I send almost everyone to pelvic PT. Almost any time there's pelvic pain, whether it's from endometriosis, a childbirth injury, or muscle tension from compensating for an injury somewhere else in the body, there's some kind of muscular or nerve component involved. 

Pelvic floor therapists relax overly tense muscles, retrain weak ones, and even work with dilators for people dealing with vaginal narrowing from menopause or cancer treatment. It's never wrong to ask for a referral to pelvic PT.

MIGS is a subspecialty a lot of people, and even some general OB/GYNs, don't know exists. The name makes it sound like we just do surgery, but we also train specifically as pain specialists. If pain is showing up across your period, your sex life, and your bathroom habits, and your general OB/GYN isn't sure what to do with that, a MIGS specialist is worth seeking out.

How to push for a second opinion

If your doctor's response to real pain is "that's just normal," or “have a glass of wine and relax," that's not a plan, that's a brush-off. Get specific instead. You can say: this is really debilitating, this is not normal, what are our next steps? Can we consider imaging studies? Is there a specialist you could refer me to?

If you're still hitting a wall with no evaluation and no options, that's when it's time to look elsewhere. Ask your current provider for a referral, or lean on patient communities. I’ve had patients share that their local Facebook groups, endometriosis support groups, and online networks have been a helpful place to find the doctor who takes them seriously. I see patients who traveled a long way to find me because someone in a group like that recommended me by name.

The takeaway

Underneath all of this is a cultural habit of staying quiet about periods, sex, and bowel symptoms because they feel too embarrassing to bring up. I call it the emperor's new clothes phenomenon: the moment one person says a symptom out loud, someone else in the room almost always says, "Wait, I have that too." 

My husband had no problem telling his boss he needed the afternoon off for physical therapy after he hurt his hip. Most women would never say the same thing about needing time off for a gynecology appointment.

Breaking that silence is often the first step toward getting the right care. You don't have to spend a quarter of your life in pain to prove it's real.