Pelvic Pain Evaluation and Care

Pelvic pain has many possible causes, from a urinary infection or painful periods to endometriosis or an ovarian cyst. We take your symptoms seriously, order the right tests, help you arrange an exam when one is needed, and tell you plainly when pain needs emergency care.

Become a Patient

A woman lies curled on a sofa, holding her lower belly in discomfort.

Understanding Pelvic Pain

Pelvic pain is pain in the lowest part of the abdomen, below the belly button and between the hips. It can be sharp or dull, steady or cramping, and it may come and go with your cycle or stay constant. Acute pelvic pain starts suddenly and may need urgent attention, while chronic pelvic pain lasts six months or longer and can affect work, sleep, exercise, sex and mood. Pelvic pain is common, and it is real pain that deserves a careful look.

Many organs share the pelvis, so the list of possible causes is long. Common causes include urinary tract infections, painful periods, endometriosis, ovarian cysts, fibroids, pelvic inflammatory disease from a sexually transmitted infection, and digestive causes such as constipation, irritable bowel syndrome or appendicitis. Pregnancy-related causes, including ectopic pregnancy, must always be considered in anyone who could be pregnant. Tight or painful pelvic floor muscles can cause pain too. Men can have pelvic pain as well, often from the prostate, the bladder or a hernia, and we evaluate that too.

Professional care matters because some causes of pelvic pain are emergencies, and others are very treatable once they are found. Finding the cause usually takes more than one step: a careful history, labs such as a urine test and a pregnancy test, often an ultrasound, and often a pelvic exam. We start by telehealth for patients physically located in Utah at the time of the visit, order labs at a local lab and imaging at a local imaging center, and help you arrange an exam when one is needed.

Signs & Symptoms of Pelvic Pain

Cramping or aching low in the abdomen. Pain below the belly button, on one side or both.
Pain with periods. Cramps that are severe, getting worse over time, or not helped by usual pain relievers.
Pain with sex. Pain during or after intercourse, either deep or near the opening.
Pain with urination or bowel movements. Burning, pressure or pain when emptying the bladder or bowels.
Pain between periods. Pain that appears mid-cycle or at unpredictable times.
Unusual discharge or bleeding. Changes in discharge, or bleeding between periods, along with pain.
Pressure or heaviness. A sense of fullness or pressure in the pelvis.
Pain that spreads. Pain that moves into the lower back, thighs or rectum.

What to Expect

A video visit about your pain, cycle, bladder and bowel habits, sexual health and the chance of pregnancy
A pregnancy test and urine test, with other labs at a local lab as needed
A pelvic ultrasound at a local imaging center when it will help
Help arranging a pelvic exam or swabs that need an in-person visit
Clear guidance on warning signs that need emergency care
Treatment for the cause, with referral to gynecology or another specialist when needed

How We Evaluate and Treat Pelvic Pain

Assessment

We start with a detailed video visit about where the pain is, when it started, what makes it better or worse, and how it relates to your cycle, bladder, bowels and sex. We always ask whether you could be pregnant. We order a pregnancy test and a urine test, and often blood tests and STD testing, at a local lab.

Imaging and Exam

A pelvic ultrasound at a local imaging center is often the next step and can show ovarian cysts, fibroids and other causes. Many causes also need a pelvic exam or swabs that cannot be done by video, and we will help you arrange an in-person visit. Our in-person clinic is being planned in Cache County, Utah. Until it opens, we help you arrange the exam nearby.

Treatment and Follow-Up

Treatment depends on the cause, such as antibiotics for an infection, anti-inflammatory or hormonal medicine for painful periods or endometriosis, or a plan for digestive causes. We follow up on how you are doing and refer you to gynecology, pelvic floor physical therapy or another specialist when that is the right next step.

Benefits

Taken Seriously

Pelvic pain is real pain. We listen carefully and keep looking until the cause is clear.

A Clear Plan for Testing

You will know which labs, imaging and exams you need and why, and we help you arrange them.

Experience in Women's Health

Brooke Tuttle, FNP-C, is a board-certified family nurse practitioner who has practiced family medicine since 2017. Before that, she spent 11 years as a registered nurse in labor and delivery, postpartum and the well-baby nursery.

Coordinated Referrals

When you need gynecology, imaging or physical therapy, we help coordinate care so nothing falls through the cracks.

Your Care Journey

First Visit (Week 1)

We talk through your pain by video, order a pregnancy test, urine test and other labs at a local lab, and arrange an ultrasound or exam when needed.

Weeks 2 to 4

We review results with you, start treatment for any cause we find, and decide whether more testing or a referral is needed.

Months 2 to 3

We check how treatment is working. If pain continues, we look further, which may include a referral to gynecology or pelvic floor physical therapy.

Long-Term Care

For chronic pelvic pain, we build a long-term plan that may combine medicine, physical therapy, sleep and stress support, and keep your specialists connected.

Warning Signs That Need Emergency Care

Sudden, severe pelvic pain. Call 911 or go to the nearest emergency room. This can be a sign of a twisted ovary, a burst cyst, appendicitis or another emergency.

Pain with a positive pregnancy test or a possible pregnancy. Call 911 or go to the nearest emergency room. Pelvic pain early in pregnancy, especially with bleeding, shoulder pain or dizziness, can be an ectopic pregnancy, which is life-threatening.

Fainting, lightheadedness or a racing heart. Call 911 or go to the nearest emergency room. These can be signs of internal bleeding.

Pain with fever and vomiting. Call 911 or go to the nearest emergency room. This can signal appendicitis or a serious pelvic infection.

Heavy vaginal bleeding with pain. Soaking through a pad every hour for two hours or more needs emergency care.

Pain with fever or unusual discharge. Even without vomiting, this can be pelvic inflammatory disease and needs prompt in-person care, such as at urgent care, the same day.

Pain that keeps getting worse. Pain that steadily worsens over hours needs prompt evaluation.

If you are unsure whether your pain is an emergency, it is safer to be seen. Call 911 or go to the nearest emergency room.

Common Causes of Pelvic Pain

Urinary tract infection. Burning with urination, urgency and pressure above the pubic bone.

Painful periods. Cramping that starts with or just before a period, sometimes severe enough to miss school or work.

Endometriosis. Tissue similar to the uterine lining grows outside the uterus, causing painful periods, pain with sex and chronic pain.

Ovarian cysts. Most are harmless and go away on their own, but some cause pain, and a cyst can rarely twist or burst.

Pelvic inflammatory disease. An infection of the uterus, tubes or ovaries, often from an untreated STD, that needs prompt antibiotics.

Digestive causes. Constipation, irritable bowel syndrome and appendicitis can all cause pain low in the abdomen.

Evidence-Based Treatment

Treatment follows the cause. Urinary infections and pelvic inflammatory disease are treated with antibiotics, and partners may need STD testing and treatment. Painful periods and endometriosis often respond to anti-inflammatory medicine and hormonal treatments, such as birth control pills or a hormonal IUD, with referral to gynecology for further options. Many ovarian cysts go away on their own and are rechecked with ultrasound, while large or concerning cysts need specialist care. Pelvic floor physical therapy helps when muscles are part of the pain, and chronic pelvic pain often improves most with a plan that combines several approaches.

Common Questions About Pelvic Pain

When is pelvic pain an emergency?

Call 911 or go to the nearest emergency room for sudden severe pain, pain with fever and vomiting, fainting or feeling faint, or any pelvic pain when you have a positive pregnancy test or could be pregnant, since an ectopic pregnancy can be life-threatening. Heavy bleeding with pain also needs emergency care.

Can pelvic pain be evaluated by telehealth?

Telehealth is a good place to start for pain that is not an emergency. We take a detailed history and order labs at a local lab and an ultrasound at a local imaging center. Many causes also need a pelvic exam or swabs, which need an in-person visit, and we will help you arrange one.

Why do I need a pregnancy test?

Anyone with pelvic pain who could be pregnant needs a pregnancy test, even if pregnancy seems unlikely, because ectopic pregnancy and miscarriage can cause pelvic pain and need urgent care. The result also guides which imaging and medicines are safe.

Could my pain be endometriosis?

Endometriosis is a common cause of painful periods, pain with sex and chronic pelvic pain. It often does not show on ultrasound, so the diagnosis is usually based on symptoms, and treatment can start without surgery. If symptoms are severe or do not improve, we refer you to gynecology.

What if no cause is found?

Sometimes the first round of tests is normal, and that is useful information. Chronic pelvic pain often has more than one contributor, including muscles, nerves, the bladder and the bowel. We keep working with you, which may include pelvic floor physical therapy or a specialist referral.

Does insurance cover pelvic pain care?

Sagebrooke Family Medicine is an insurance-based practice, and we are in the process of joining insurance plans. What you pay depends on your plan, including any copay, deductible or coinsurance. Contact the practice to check whether your plan is accepted, and check with your insurer about coverage for labs, ultrasound and other imaging, and specialist referrals.

Get Help for Pelvic Pain

If your pain is not an emergency, request a telehealth visit and we will start finding the cause. For sudden severe pain, call 911 or go to the nearest emergency room.