What is pelvic pain?
Pelvic pain refers to any pain felt in the lower abdomen, between the navel and the top of the thighs. It is one of the most common reasons for a gynaecological consultation, affecting approximately 1 woman in 5 at some point during her reproductive life.
A distinction is made between:
- Acute pelvic pain: sudden in onset, sometimes requiring urgent management
- Chronic pelvic pain: present for more than 6 months, recurrent or persistent, with a significant impact on quality of life
Do not normalise your pain. Significant or recurrent pelvic pain should be investigated: it is often a sign of a treatable condition.
Main gynaecological causes
Endometriosis
Endometriosis is the leading cause of chronic pelvic pain in women of reproductive age. Tissue similar to the endometrium grows outside the uterus (ovaries, fallopian tubes, peritoneum, intestine), causing intense cyclical pain, very painful periods, and sometimes infertility. Diagnosis is often delayed by an average of 7 years in France.
Uterine fibroid
Fibroids (myomas) are benign tumours of the uterus that can cause pelvic pain, severe menstrual cramps, and heavy periods. Their size and location determine the intensity of symptoms.
Adenomyosis
Adenomyosis corresponds to the presence of endometrial tissue within the muscular wall of the uterus (myometrium). It causes painful, heavy periods and an enlarged uterus, and is often associated with endometriosis.
Genital infections (salpingitis, endometritis)
An infection of the fallopian tubes (salpingitis) or the endometrium (endometritis) causes acute pelvic pain, often accompanied by fever, abnormal discharge, and pain on cervical movement. Prompt antibiotic treatment is essential to prevent long-term consequences on fertility.
Post-surgical adhesions
After abdominal or pelvic surgery (appendectomy, endometriosis surgery, caesarean section), scar tissue bands can form between organs, causing chronic pain that is sometimes difficult to localise.
Pelvic pain syndrome
According to the CNGOF 2025 guidelines, pelvic pain syndrome (formerly termed "chronic pelvic pain") is now recognised as a distinct entity, often multifactorial, involving musculoskeletal, neurological, and psychological components in addition to organic causes.
Ovarian cyst
An ovarian cyst can cause lateralised pelvic pain or a sensation of heaviness, or — in the event of torsion or rupture — acute pain requiring urgent management.
Non-gynaecological causes not to overlook
Pelvic pain may also have a digestive or urinary origin:
- Irritable bowel syndrome (IBS): lower abdominal pain, bloating, alternating constipation and diarrhoea
- Interstitial cystitis: chronic pelvic pain associated with frequent urges to urinate
- Inguinal hernia: groin pain, sometimes mistaken for pelvic pain
- Musculoskeletal problem: pelvic floor dysfunction, hip osteoarthritis
Diagnostic assessment with Dr. Maazouzi
Thorough medical history
Dr. Maazouzi takes time to understand your pain: exact location, intensity, cyclical or constant nature, relationship with periods or intercourse, triggering factors, and impact on your daily life.
Gynaecological examination
The clinical examination allows detection of tenderness on palpation of the uterus or ovaries, a pelvic mass, or signs of infection.
Pelvic ultrasound scan
Endovaginal ultrasound is the first-line investigation for exploring gynaecological causes: fibroid, ovarian endometrioma, cyst, hydrosalpinx.
Pelvic MRI
MRI is the gold-standard investigation for deep endometriosis, adenomyosis, and lesion mapping before surgery.
Diagnostic laparoscopy
When non-invasive investigations do not provide a conclusion, a laparoscopy (minimally invasive surgery under general anaesthesia) can be performed to directly visualise the pelvic organs.
Treatments according to cause
Endometriosis and adenomyosis
Hormonal treatment (progestins, combined pill, intrauterine device) and/or laparoscopic surgery for excision of lesions.
Fibroid
Depending on location and symptoms: watchful waiting, medical treatment (hormonal IUD, progestins) or surgery (hysteroscopy, myomectomy, vNOTES).
Genital infections
Targeted antibiotic therapy, sometimes combined with hospitalisation and intravenous treatment.
Pelvic pain syndrome
Multidisciplinary approach: gynaecological treatment, pelvic floor rehabilitation, psychological support, pain management by a pain specialist.
Adhesions
Surgical treatment by laparoscopy to release the adhesive bands, with benefit assessed on a case-by-case basis.
When to seek consultation without delay?
As an emergency if you experience:
- Sudden and very intense pelvic pain
- Fever associated with pelvic pain
- Late period with pain (possible ectopic pregnancy)
- Abnormal bleeding associated with pain
As a scheduled appointment if you experience:
- Very painful periods over several cycles
- Persistent pelvic pain for more than one month
- Pain during sexual intercourse (dyspareunia)
- Difficulties conceiving associated with pain
Book an appointment with Dr. Yasmine Maazouzi at the Hôpital Privé Beauregard (23 Rue des Linots, Bât. B5 ICOGM, Marseille 13004) for a full assessment of your pelvic pain.