Chronic pelvic pain syndrome (CPPS) describes long-term pain in the pelvic area, which is below the abdomen and between the hip bones. It is more common in females but can also affect males.

CPPS is a pain in the pelvic area that lasts for more than 6 months. The pain is severe and may limit a person’s everyday activities.

This pain may be constant or may come and go. People may also experience changes in urination and sexual dysfunction.

CPPS may also have links to mental health issues, such as depression and anxiety.

This article examines the symptoms, causes, diagnosis, and treatment of pelvic pain syndrome.

A note about sex and gender

Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.

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People with CPPS may experience a dull, aching pain or sharp, burning, or shooting pain. They may also feel a heaviness or pressure within the pelvic area.

The pain may follow a cycle, such as menstruation, or occur during certain activities, such as during sex, urinating, or before or after eating.

Symptoms of CPPS in females may also include:

Symptoms of CPPS in males may include:

CPPS may begin in various systems in the body, including the:

  • urogynecological system
  • gastrointestinal system
  • musculoskeletal system
  • nervous system

A combination of psychological factors and atypical function of the immune, neurological, and endocrine systems may cause symptoms of CPPS.

In females

Causes and risk factors of CPPS in females may include:

Other medical conditions that may link to or co-occur with CPPS include:

In some cases, doctors may not be able to find a specific cause for CPPS.

In males

Causes and risk factors of CPPS in males may include:

To diagnose pelvic pain syndrome, a doctor may carry out a physical exam to inspect the muscles and organs in the pelvic area, which includes the bladder and lower abdominal wall, and in females, the cervix and uterus.

A doctor may also examine the male prostate gland and genitals.

Doctors may also use certain tests to diagnose pelvic pain syndrome, such as:

  • a urine test for laboratory examination, including testing for infections
  • a pelvic ultrasound
  • a cystoscopy with hydrodistension, where doctor will use a thin tube with a camera to examine inside the bladder while filling it with water to find out the cause of pain
  • a laparoscopy, where a surgeon makes a small incision in the abdomen to examine the abdominal and reproductive organs

A doctor will examine the pelvic area for any signs of pain or tenderness.

In some cases, CPPS can be due to a psychological pain perception disorder, so there may be few to no physical changes to observe.

Treatment will depend on the underlying cause of pelvic pain, and treating the cause may resolve pelvic pain. If there is no known cause, treatment aims to relieve pain and prevent it from worsening.

Depending on the underlying cause, treatment for CPPS may include:

Doctors may be able to treat CPPS if they discover the underlying cause of pain.

If there is no known cause, treatment focuses on relieving pain and preventing it from worsening.

According to a 2022 article, gynecological surgery relating to CPPS may result in a 46% improvement in pain and a 31% improvement in depression symptoms.

Physical therapy may also be an effective treatment. After receiving physical therapy, people with CPPS had a 22% reduction in medication use compared with those who did not undergo physical therapy.

Physical therapy may help reduce pain and urinary symptoms such as increased frequency and urgency.

Treating the underlying cause of CPPS may result in an optimal outlook, including improved quality of life and management of any co-existing psychological issues.

Pelvic pain syndrome is long-term, persistent pain in the pelvic area lasting for more than 6 months.

The pain may come and go and cause other symptoms, such as sexual dysfunction, changes in urination, or lower back pain.

CPPS may affect a person’s emotional and mental health and may negatively affect their quality of life.

Treatment may include lifestyle changes, physical therapy, medications, or surgery.

If doctors know the underlying cause of CPPS, they may be able to treat it. If there is no known cause, treatment can help relieve pain and improve quality of life.