Complex Female Pelvic Pain: A Case Series From a Multidisciplinary Clinic in Urogynecology and Physiatry

Jennifer Nicole Lillemon, Rahel Nardos, Matthew P. Kaul, Angela N. Johnson, Amy Choate, Amanda L. Clark

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


Objective The internal pelvic floor muscles that support the pelvic viscera lie within the external pelvic structures, which support posture and locomotion. The presence of pain in the hip, groin, leg, abdomen, and/or back in patients with pelvic pain suggests that external pelvic sites may act as pain generators that contribute to chronic pelvic pain (CPP). The aim of this study was to report musculoskeletal diagnoses resulting from including a physiatry evaluation as part of a Multidisciplinary Pelvic Pain Clinic for women with complex chronic pain. Methods This retrospective case series was conducted by chart review of all women attending the clinic from February 2016 through March 2018. Variable definitions were created for each demographic and clinical characteristic and used to guide a structured review of the chart. Descriptive statistical analysis was performed. Results Ninety-six percent of the 68 women (mean age, 51 years) had CPP of 6 months' duration or longer. Levator ani tenderness was present in 81% and obturator internus tenderness in 81%. Seventy-one percent of women had failed pelvic physical therapy. Musculoskeletal diagnoses included osteoarthritis, tendinopathies, enthesopathies, osteitis pubis, ischiofemoral impingement, Paget disease, and other systemic conditions. Conclusions Musculoskeletal abnormalities were common in this highly selected cohort of complex CPP cases with external pelvic symptoms. The imaging findings and specific diagnoses allowed targeted therapy beyond generalized physical therapy for CPP. The expertise of urogynecologists and physical therapists who evaluate the internal pelvic muscles and viscera combined with the physiatrist's expertise in musculoskeletal assessment and imaging provides an expanded, collaborative approach for managing these patients.

Original languageEnglish (US)
Pages (from-to)E34-E39
JournalFemale Pelvic Medicine and Reconstructive Surgery
Issue number2
StatePublished - Mar 1 2019
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2019 Wolters Kluwer Health, Inc. All rights reserved.

Copyright 2019 Elsevier B.V., All rights reserved.


  • complex pelvic pain
  • diffuse idiopathic skeletal hyperostosis
  • greater trochanteric pain syndrome
  • osteitis pubis
  • pelvic enthesopathy
  • pelvic floor myalgia
  • pelvic pain
  • physiatry


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