Pelvic Pain: Causes and Solutions for Women - Obstetrics and Gynecology

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Pelvic pain in women can be a complex issue, often stemming from a variety of causes. Based on the symptoms you've described, it’s essential to consider several potential factors that could be contributing to your discomfort during menstruation and after sexual activity.

Firstly, menstrual pain, known as dysmenorrhea, is a common experience for many women. It can manifest as cramping in the lower abdomen and may radiate to the pelvic area. This pain is typically caused by the release of prostaglandins, which are chemicals in the body that cause the uterus to contract. In some cases, the pain can be severe enough to interfere with daily activities, as you've described.
Additionally, conditions such as endometriosis—a condition where tissue similar to the lining inside the uterus grows outside of it—can lead to significant pelvic pain, especially during menstruation. Endometriosis can cause painful periods, pain during intercourse, and chronic pelvic pain. Another possibility is pelvic inflammatory disease (PID), which is an infection of the reproductive organs that can cause pain and discomfort.

The sensation of pain that feels like "bones rubbing" or "shifting" could also be related to musculoskeletal issues. For instance, pelvic floor dysfunction can lead to pain in the pelvic region and may be exacerbated by certain positions or movements. This dysfunction can result from various factors, including previous injuries, childbirth, or even prolonged sitting.

Your experience of pain during sexual activity, particularly after penetration, can also indicate a few different issues. Vaginal infections, such as yeast infections or bacterial vaginosis, can cause discomfort during intercourse. Additionally, psychological factors such as anxiety or past trauma can contribute to pain during sexual activity, known as dyspareunia.
Given the complexity of pelvic pain, it is crucial to seek a thorough evaluation from a healthcare provider, preferably a gynecologist. They can perform a physical examination, possibly including a pelvic exam, and may recommend imaging studies like an ultrasound to rule out conditions such as ovarian cysts or fibroids.
In terms of management, treatment options will depend on the underlying cause of your pain. For menstrual cramps, over-the-counter pain relievers such as ibuprofen or naproxen can be effective. Hormonal contraceptives may also help regulate or reduce menstrual pain. If endometriosis or another condition is diagnosed, specific treatments may include hormonal therapy or surgical options.

For pelvic floor dysfunction, physical therapy focused on the pelvic area can be beneficial. A physical therapist specializing in pelvic health can provide exercises and techniques to strengthen and relax the pelvic floor muscles.

In summary, pelvic pain can arise from various sources, including menstrual cramps, endometriosis, infections, and musculoskeletal issues. It is essential to consult with a healthcare professional to identify the specific cause of your pain and develop an appropriate treatment plan. Remember, you do not have to endure this discomfort alone, and effective management options are available to improve your quality of life.