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chronic overlapping pelvic pain conditions
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Are You Suffering From Chronic Overlapping Pelvic Pain Conditions? We Can Help!

Part 1: Endometriosis and Vulvodynia

Chronic pelvic pain, sometimes abbreviated to “CPP”, is defined as “pain in the abdomen or pelvis for at least 14 days per month and severe enough to cause functional limitations” by a recent literature review of chronic pelvic pain5. The cause of chronic pelvic pain is often multifactorial and can be the result of conditions such as:

  • endometriosis
  • Vulvodynia (or vestibulodynia)
  • interstitial cystitis/bladder pain syndrome
  • irritable bowel syndrome (IBS)

Many times, patients who suffer from chronic pelvic pain often suffer from other chronic overlapping pain conditions as well including5,3,4:

  • Fibromyalgia
  • temporomandibular disorders (TMJD)
  • migraine headaches
  • chronic tension headaches
  • chronic low back pain
  • myalgic encephalomyelitis/chronic fatigue syndrome
  • complex regional pain syndrome or “CRPS”

In part one of this series, we will focus on endometriosis and vulvodynia and how the two conditions can be interrelated and are known chronic overlapping pelvic pain conditions. First, we will briefly describe each condition:

Endometriosis: Endometrial-LIKE tissue is present outside of the uterus. This can be anywhere in the body, but most commonly seen in the pelvic peritoneum, ovaries, fallopian tubes, rectum, colon, bladder, or appendix. Symptoms of the disease vary person to person, but may include: painful periods, non-cyclic pelvic pain, painful sex, painful urination, pain with bowel movements/difficulty with bowel movements (dyschezia), and infertility. Often the diagnosis is delayed, due to the overlapping symptoms with many other health conditions, and to get a formal diagnosis requires confirmation via laparoscopic surgery.3

Vulvodynia: defined as persistent vulvar pain, meaning in the external genital tissues, present for at least three months. It can be provoked by contact or spontaneous. Symptoms can include: burning, stinging, general irritation, and a less common symptom of vulvar itching. Painful sex, or commonly seen as dyspareunia, can often be caused by vulvodynia.4

In both of these conditions, there is an increase in nerve fiber density surrounding the affected tissues, oftentimes creating pain with sex either at the entrance of the vagina/external genitalia (vulvodynia) or deeper penetrative pain (often due to endometriosis and termed deep dyspareunia), or both3,4. On top of the increased nerve fibers, pain processing becomes distorted over time due to phenomena called central sensitization, peripheral sensitization, and cross sensitization. This is when the nervous system becomes overly sensitive to pain signals, and can lead to inappropriate firing of neurons in other regions of the body, away from the original injury or pathological source. Check out this article on our website explaining this mechanism in further detail.

Recent evidence has shown early treatment of endometriosis and vulvodynia can decrease risk of the development of chronic pain and central sensitization1. In order to be successful in managing chronic pelvic pain, it is essential that care is multidisciplinary, which includes addressing the musculoskeletal contributors of pain in both endometriosis and vulvodynia. It has been estimated that among patients with chronic pelvic pain, 60-90% have musculoskeletal dysfunction contributing to their pain2,6. Pelvic floor PT can make a huge difference in quality of life by helping to manage symptoms due to muscle tension and nerve pain, including in chronic overlapping pelvic pain conditions,

At Femina Physical Therapy, all of our physical therapists have specialized training to address the musculoskeletal components of your pain and will work with your other healthcare providers in a collaborative manner to maximize symptom-relief and improve your quality of life. Whether you are experiencing chronic overlapping pelvic pain conditions or just want to take preventative measures to ensure they don't get worse, feel free to reach out to our team to get started.


  1. Allaire C, Bedaiwy MA, Yong PJ. Diagnosis and management of endometriosis. CMAJ. 2023;195(10):E363-E371. doi:10.1503/cmaj.220637


  1. Fitzgerald CM, Neville CE, Mallinson T, Badillo SA, Hynes CK, Tu FF. Pelvic floor muscle examination in female chronic pelvic pain. J Reprod Med. 2011;56(3-4):117-122.


  1. McNamara HC, Frawley HC, Donoghue JF, et al. Peripheral, Central, and Cross Sensitization in Endometriosis-Associated Pain and Comorbid Pain Syndromes. Front Reprod Health. 2021;3:729642. Published 2021 Sep 1. doi:10.3389/frph.2021.729642


  1. Mwaura AN, Marshall N, Anglesio MS, Yong PJ. Neuroproliferative dyspareunia in endometriosis and vestibulodynia. Sex Med Rev. 2023;11(4):323-332. doi:10.1093/sxmrev/qead033


  1. Till SR, Nakamura R, Schrepf A, As-Sanie S. Approach to Diagnosis and Management of Chronic Pelvic Pain in Women: Incorporating Chronic Overlapping Pain Conditions in Assessment and Management. Obstet Gynecol Clin North Am. 2022;49(2):219-239. doi:10.1016/j.ogc.2022.02.006


  1. Sedighimehr N, Manshadi FD, Shokouhi N, Baghban AA. Pelvic musculoskeletal dysfunctions in women with and without chronic pelvic pain. J Bodyw Mov Ther. 2018;22(1):92-96. doi:10.1016/j.jbmt.2017.05.001


What Our Patients Have to Say


Testimonial by R.M., Age 40

I can’t speak highly enough of the theapists at Femina Physical Therapy and how much they have helped me grow, discover, and love my body. I had had painful sex for my entire life, and didn’t know that there was anything that could be done about it. It was at the point where my husband and I were not having sex for MONTHs, because it was just too frustrating, and I hated feeling like I was the ONLY woman out there who had this problem, especially at my age. I finally brought it up to my doctor because I was turning 40 and my husband and I were barely having enough sex to conceive. And she brought up pelvic floor, PT. I didn’t even know this was a “thing”.

Read more: Testimonial by R.M., Age 40

Testimonial by Y.L. (mom of 2)

After having my second baby via C-section I searched for months to try to find help for my lower back pain and separated abdominal muscles. I finally came across Heather Jeffcoat via a mommy blog. I reached out to her via email and set my first appointment. My first appointment went amazing … she listened to what my symptoms, check my separation and explained to me in detail what the next steps would be. Not only did my abdominal separation go from 3 to about 1 -1/2 but my back has pain has significantly reduced. I’m personally recommending all my mommy friends to Heather!

Y.L. (mom of 2)

Testimonial by R.S.

I wanted to thank you so much for helping me get through something I thought I may never be able to. We have achieved pain-free intercourse and this has really solidified our marriage. We are so grateful to you for all the work you do! Thank you!!

-- R.S.

Testimonial by Jackie W.

I was in multiple car accidents a decade ago, and I have been to many physical therapists through the years without success. They found the root of my lower back pain problems and after nearly a decade of barely being able to walk I finally can again without pain. They are also the best pelvic floor pts and the only ones who found the connection between my pelvic floor and lower back problems. If you need help with physical pain, they are your answer.

-- Jackie W., 1/19/17 via Yelp!

Testimonial by T.H.

I started seeing Heather in October 2014. For more than two years, I had been suffering from painful urinary tract infection type symptoms after my bartholins gland surgery which included constant burning and urinary frequency sensation that led to more and more painful intercourse. I had made multiple visits to internist, obgyn and urologist's offices, went through a range of treatment with UTI and bladder frequency medication that included antibiotics, vesicare, estrogen cream, but nothing worked.

Read more: Testimonial by T.H.

Testimonial by P.M.

I was hopeful but frankly skeptical when the doctor treating me for Interstitial Cystitis recommended that I go to Heather for physical therapy. Medication and diet helped control my IC symptoms, but I had never heard of physical therapy being used to treat IC. The education and treatment I received from Heather was a revelation. She explained that the pain I experienced with IC had helped create a cycle of muscle guarding which affected the entire pelvic area. I had no idea of the amount of tension being held there. No wonder my husband and I had not been able to have sexual intercourse for years!

Read more: Testimonial by P.M.

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