Pelvic Pain Primer for Interventional Radiologists: From Mystery to Mastery

Learning Objectives: 1. Identify and classify IR-treatable etiologies of chronic pelvic pain

2. Review procedural approaches for intervention

3. Promote IR as a central player in chronic pelvic pain care

Background: Chronic pelvic pain (CPP), defined as non-cyclical pain lasting over six months, affects approximately 26% of women {1}. Yet despite its high prevalence, many patients face years of misdiagnosis, inadequate treatment, or under-recognition before receiving appropriate care. CPP accounts for 20% of gynecology visits, 12% of hysterectomies, and 40% of gynecologic laparoscopies, underscoring the prolonged distress and repeated interventions these patients endure in search of relief {2}.

The primary etiologies of CPP can be grouped into four categories:

• Vascular, e.g., pelvic venous disease


• Neurologic, e.g., pudendal neuralgia, post-radiation neuropathy


• Inflammatory, e.g., endometriosis, adhesions, chronic PID


• Musculoskeletal, e.g., sacroiliac joint dysfunction, myofascial pain syndromes

Interventional radiologists frequently encounter CPP patients but are often without a structured diagnostic or therapeutic framework. A systematic approach can help streamline care amid the diagnostic complexity of pelvic pain. Interventional radiology is uniquely positioned to provide minimally invasive treatments and to coordinate multidisciplinary care with gynecology, urology, pain management, and oncology. Leadership opportunities include establishing IR-led CPP programs and standardizing treatment algorithms.

Clinical Findings/Procedure Details: This session uses case-based discussion to:

• Recognize clinical symptoms, presentations, and imaging findings for causes of IR-treatable pain


• Review relevant anatomy including pelvic nerves such as the pudendal and genitofemoral nerves


• Classify pelvic pain etiologies in a reproducible framework


• Review treatment strategies including embolization, nerve blocks, nerve ablation, and other minimally invasive procedures, focusing on procedural techniques and indications

Conclusion and/or Teaching Points: Attendees will gain a structured approach to chronic pelvic pain, improving diagnostic confidence, treatment planning, and patient outcomes. Learners will leave prepared to identify pain sources, select appropriate interventions, and lead in multidisciplinary pelvic pain care.