Chronic Pelvic Pain

Chronic pelvic pain is a unique medical issue which can be difficult to diagnose and treat effectively for several reasons. 

 

The cause of pain is often obscured by the complexity of the pelvis, which includes many different organ systems including: 

 

- Reproductive tract (vulva, vagina, cervix, uterus, ovaries)

- Lower urinary tract (urethra, bladder)

- Lower gastrointestinal tract (intestines)

- Musculoskeletal system (pelvic floor, back, sacroiliac joint, ischial bursa)

- Neurological (peripheral pelvic nerves as well as central nervous system)

 

Understanding pelvic pain requires a specialist who can investigate and consider these multiple systems.

 

In addition, pain in the abdomen behaves differently than most other areas of the body. Unlike the head and limbs, where nerves tend to identify pain exactly where the injury is located, pelvic nerves tend to “refer” pain to other locations. Thus a patient who has left sided lower abdominal pain may languish in pain if only their left abdomen is evaluated, because the actual problem may be located in the cervix or some other distant site. Dr. Soffer is keenly aware of how commonly pain can be referred to other locations, and is adept and thorough at evaluating the pain's true source. 

 

Perhaps the most difficult part of caring for patients with chronic pelvic pain is helping patients reverse their bodies' maladaptive secondary effects of longstanding pain. As the body copes with ongoing pain, there can be negative effects on the local muscles, nerves, and central nervous system which can require long-term neuromuscular retraining. There may also be psychological consequences of suffering with long-term pain, such as depression and anxiety, which are important to treat for full chronic pelvic pain recovery. 

 

Dr. Soffer addresses all of these many factors which contribute to chronic pelvic pain. 

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Overall approach

 

Dr. Soffer avoids simply masking pain with medication, since this tends to be ineffective in the long term and can cause addiction. Dr. Soffer always focuses on discerning the primary and secondary causes of the pain to most effectively treat the problem long term. Every evaluation begins with a detailed history and physical examination and encompasses all likely contributing parts of the body.

 

Additional evaluations may include blood and urine testing, infection screening, biopsy, ultrasound, CT scan and/or MRI.

 

After identifying contributing factors, Dr. Soffer reviews each area of concern in detail with her patients, carefully explaining possible causes and treatment options. Each patient plays an integral role selecting a treatment plan which is in line with their goals and preferences. 

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Conditions Evaluated and Treated​