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  • Nicole Cozean, PT, DPT, WCS

What Happens When Endometriosis Is Not the Underlying Cause of Pelvic Pain

New research from the University of Calgary explores the role of endometriosis in chronic pelvic pain. They examined a group of more than 250 women who had been experiencing pelvic pain for more than six months.

Endometriosis and Pelvic Pain

The first interesting finding was that only 26.7% of these women were found to have endometriosis on surgical evaluation. Endometriosis is often the first culprit that many doctors suspect when confronted with pelvic pain, but this study shows that nearly 3 in 4 women with pelvic pain did not have any evidence of endometriosis.

The second finding is even more important - there was no difference in pain or clinical symptoms between women with and without endometriosis. This suggests that for many women with endometriosis, there may be other factors that are contributing to their symptoms that are shared in various presentations of chronic pelvic pain.

"Women with negative laparoscopy and confirmed endometriosis had similar clinical and pain variables including rates of pain sensitization."

Endometriosis is frequently accompanied by pelvic floor dysfunction, which may be either causing or exacerbating pelvic pain. Endometriosis itself creates an inflammatory response but even the surgeries performed to treat the condition cause scar tissue and inflammation, which can also negatively influence the pelvic floor. Pelvic floor physical therapy works to address this underlying dysfunction, reducing the pain, inflammation, and other symptoms associated with endometriosis.

Pain sensitization is another key component to all forms of chronic pelvic pain--including endometriosis. Any time pain is experienced over a long period of time, the neurological system adapts. Pain receptors become more sensitive and the central nervous system amplifies the response to the receptors, creating a disproportionate reaction to stimuli. Even when the source of the pain has been removed, if the nervous system is not addressed then the pain cycle may continue.

Additional Resources

Dr. Nicole Cozean is the founder of PelvicSanity physical therapy, Orange County's premier pelvic floor physical therapy clinic. One of only 270 PTs to be board-certified in the pelvic floor, and the first PT to serve on the ICA Board of Directors, Nicole is the author of the acclaimed and best-selling book The Interstitial Cystitis Solution (2016). She is an adjunct professor at her alma mater, Chapman University. The PelvicSanity blog focuses on presenting practical, positive information to help patients beyond the walls of Nicole's clinic.

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