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What contributes to persistent pelvic pain?

Persistent (chronic) pelvic pain (PPP) is a complex condition. Many things may contribute to this type of pain, including:

  • biological factors (e.g. physical health conditions, inflammation and hormones)
  • psychological factors (e.g. how you think about pain and how pain impacts your sleep and mood)
  • social factors (e.g. relationships, social connections and work environments).

It’s important to remember that your pain is real, no matter what is causing it.

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Biological factors

Many conditions may contribute to persistent pelvic pain.

Period pain

Period pain can contribute to persistent pelvic pain. Period pain is when your uterus muscles tighten. It’s normal to have cramping in your pelvic area on the first two days of your period. But if pain persists after taking medicine, or if the pain interferes with your daily life, you may need to see your doctor.


Endometriosis is when cells similar to those that line your uterus are found in other parts of your body, such as the lining of your pelvis or on your bowel, bladder and ovaries. Endometriosis can be associated with persistent pelvic pain.


Adenomyosis is when cells similar to those that line your uterus are found in the muscle wall of your uterus. This can be associated with painful periods and persistent pelvic pain.

Irritable bowel syndrome (IBS)

Irritable bowel syndrome (IBS) is a group of symptoms, such as repeated pain in your abdomen and changes in your bowel movements (e.g. constipation and diarrhoea).

Pelvic floor dysfunction

Your pelvic floor muscles are part of a group of muscles called your ‘core’.

These muscles:

  • support your pelvic organs
  • help with bowel and bladder control
  • affect sexual function
  • support your lower back and pelvis.

Pelvic floor dysfunction means your pelvic floor muscles, ligaments and connective tissues don’t work as they should. This can cause problems with your bladder, bowel and sexual function. It can also cause persistent pain.

Painful bladder syndrome

Painful bladder syndrome is a group of symptoms, such as:

  • pain or discomfort in your bladder that gets worse as it fills up and improves once it is empty
  • needing to wee more often than normal
  • feeling an urgent, overwhelming need to wee.

Urinary tract infections (UTIs)

Urinary tract infections (UTIs) are infections in your urinary tract that can contribute to persistent pelvic pain. The infection can be in your urethra (where wee comes out), bladder and kidneys. UTIs can be short term (acute) or chronic.


Vulvodynia is the medical term for chronic pain or discomfort in the vulva that lasts at least three months. Vulva is the name for the outside parts of the female genitals. With this condition, any pressure applied to the vulva, such as having sex, inserting a tampon, using toilet paper or sitting for prolonged periods of time can be unbearable. There may not be anything physically wrong with the tissues – but the pain is real.

Chronic pelvic pain syndrome

Chronic pelvic pain syndrome is when you have persistent pelvic pain without an underlying biological condition.

Psychological factors

A range of psychological factors may influence persistent pelvic pain.


Stress can influence your pain. It activates your nervous, hormone and immune systems, which causes changes in your body and brain that can make pain worse. These changes can affect you physically and emotionally. They can also affect you psychologically (e.g. you may have trouble concentrating or remembering things).


There is a strong link between persistent pelvic pain and sleep problems, which can affect your quality of life. Poor sleep can increase the likelihood of pain and pain sensitivity. And pain can affect the quality and duration of your sleep. Disturbed sleep is also linked to depression and anxiety, which are more common with persistent pelvic pain.

Past trauma

Traumatic experiences, such as sexual assault and abuse, may be linked to persistent pelvic pain. These experiences can also cause post-traumatic stress disorder (PTSD). PTSD is when you experience ongoing fear, anxiety and memories of a traumatic event. If you haven’t worked through these experiences, it may be difficult to manage persistent pelvic pain. You can contact a qualified psychologist or counsellor for help.

Thoughts about pain

The way you think about your pain can influence the way your body responds and how you cope with it. If your nervous system is overly sensitive, even thinking about pain can make you feel pain. Being on ‘high alert’ for pain may also make your pain experience more significant.

Social factors

Different social factors can affect your pelvic pain. For example, your relationships, social connection, work environment, education and financial situation can all impact your health which, in turn, influences your pain.


Research suggests that people who have strong, healthy relationships experience less pain, disability and mental health issues. Some studies show that family conflict is linked to increased pain, while living in a supportive family is associated with reduced pain.

Social connection

If you live with persistent pelvic pain, it can be hard to engage in social activities or connect with others. This may cause you to withdraw and have fewer social contacts. But research shows that social isolation can make your pain worse, and it may also increase your risk of depression and anxiety.

Work environment

Your work environment can influence your pelvic pain, for example, if you are physically uncomfortable at work, you may experience more pain. Poor job satisfaction, an unhappy workplace, lack of social support from peers and employers, and shift work are also linked to higher pain levels.

Learn more about persistent pelvic pain

This web page is designed to be informative and educational. It is not intended to provide specific medical advice or replace advice from your health practitioner. The information above is based on current medical knowledge, evidence and practice as at May 2023.


Last updated: 26 May 2023 | Last reviewed: 08 May 2023

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