• Myofascial pelvic pain / pelvic floor dysfunction – hypertonic or trigger-point-laden pelvic floor muscles (levator ani, obturator internus), often causing deep, aching pain worsened by sitting or intercourse
• Pudendal neuralgia – entrapment or irritation of the pudendal nerve, causing burning, shooting pain in the perineum/vulva, typically worse with sitting and relieved standing
• Endometriosis-related central sensitization – even after lesions are treated, the nervous system can remain sensitized, producing chronic pain out of proportion to residual disease (a key reason gynaecologic treatment alone sometimes fails)
• Interstitial cystitis / bladder pain syndrome – often overlaps with pelvic pain, may be misdiagnosed as gynaecologic in origin; bladder filling/emptying worsens symptoms
• Abdominal wall or nerve entrapment syndromes (e.g., ilioinguinal, iliohypogastric, or genitofemoral neuralgia) – often post-surgical (C-section, hernia repair), point-tender over a specific nerve distribution, worsened by abdominal wall tensing (Carnett's sign positive)
Pain physicians also routinely screen for chronic pelvic pain syndrome as a diagnosis of exclusion, since multiple contributors (visceral, muscular, neural, psychological) often coexist — which is why treatment frequently needs a multidisciplinary approach rather than a single 'fix.'
