Why Does Anxiety Cause Pelvic Pain?

Pelvic pain, especially a condition known as chronic pelvic pain, can have serious consequences for quality of life and general health. There are many different potential causes, but anxiety can play a role.

Identification

• Somtaform disorder: A somatoform disorder is characterized by physical symptoms that cannot be explained by any other organic medical condition, substance use or mental disorder.

  Anxiety disorder: Anxiety disorders are a class of mental disorder characterized by excessive and abnormal worry and fear. Anxiety disorders are associated with changed function in certain areas of the brain and imbalance in neurotransmitters that help regulate anxiety and fear.

Causes of Pelvic Pain

• Pelvic pain has many potential causes including ovarian cysts, pelvic adhesions (bands of scar tissue in the organs near the pelvis), or endometriosis (where the lining of the uterus grows outside the uterus). In men, most often the cause is bacterial or non-bacterial chronic prostatitis, which may cause "chronic pelvic pain."

  Chronic pelvic pain is not fully understood, and is often difficult to diagnose and treat. Possible causes include musculoskelatal and gastrointestinal disorders; but most likely the cause is multifaceted. It may involve several bodily systems as well as psychological conditions. As high as 15 percent of women between the ages of 18 to 50 may experience chronic pelvic pain.

Anxiety and Pelvic Pain

• Pelvic pain may be a somatoform disorder, the result of somatization. Painful emotional memories or psychological conditions can be experienced as physical pain elsewhere in the body; this is somatization. Women with a history of sexual abuse often suffer from somatoform disorder which frequently appears as pelvic pain, and can be accompanied by anxiety. Anxiety itself, however, can also lead to a somatoform disorder causing pelvic pain. As high as 82 percent of cases of chronic pelvic pain may have some somatoform disorder. Anxiety sensitivity, which is anxiety about the symptoms of anxiety, may also play a role, increasing the likelihood of somtization.

  It is also possible that anxiety may cause pelvic pain through physical symptoms such as muscle tightness or irritable bowel syndrome. Irritable bowel syndrome, a common symptom of anxiety, (especially generalized anxiety disorder), is also a common cause of pelvic pain. Muscle tightness, another common symptom of anxiety, can lead to pelvic pain, especially where sexual function has been affected by anxiety. Pain may increase with arousal, leading to avoidance of sexual activity, leading to anxiety about sexual activity, which in turn may lead to more pain in a viscous circle.

  For all of these same reasons, anxiety may also exacerbate pelvic pain caused by other conditions.

Considerations

• Since pelvic pain is not fully understood, no final conclusions about causes can be drawn. While anxiety does appear to play a role, the possible connection remains unclear.

Misdiagnosis

• While misdiagnosis is a problem in general, in particular, a newly recognized condition, vulvodynia (chronic pain or discomfort in the vulva) may resemble chronic pelvic pain. Since the condition is not yet widely recognized, patients may sometimes be diagnosed with a somatoform disorder, with anxiety or depression a suggested possible cause.