Why has nobody been able to tell me what is wrong?

Because the pelvis is shared territory, and each specialty reasonably excludes its own causes first. What often goes unexamined is the neural and musculoskeletal layer — the nerves, joints, and pelvic floor — which is where we start.

What is pudendal neuralgia?

Pain in the distribution of the pudendal nerve, classically worse with sitting and relieved by standing. A diagnostic pudendal block is both the clearest confirmation and often the first meaningful relief a patient has had.

Do you treat endometriosis?

Not the endometriosis itself — that stays with your gynecologist. We treat the neural sensitization and musculoskeletal pain that frequently persist after the disease has been addressed, which is a different problem and often the one still limiting people.

Can pelvic pain come from the sacroiliac joint?

Yes, and it is commonly missed. SI joint pain refers into the buttock, groin, and posterior pelvis. Provocative testing and a diagnostic SI injection settle the question.

Will I need a driver?

For most pelvic blocks, yes — they are performed with sedation or as spinal injections. We confirm transportation when we schedule so it is not a surprise on the day.

Is physical therapy worth it?

In our experience it is one of the highest-yield treatments in this area, and it works better once the painful driver has been identified and treated. We refer to physical therapists we work with regularly.

Is this pain permanent?

Not usually, but it is often long-running by the time we see it, and improvement tends to be gradual. We will tell you what we think is realistically achievable before you commit to anything.

Pain Center

Pelvic Pain

A complex region requiring careful, compassionate diagnosis and treatment.

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Pelvic pain treatment at HTx Pain Institute

Overview

Understanding pelvic pain.

Chronic pelvic pain sits across gynecology, urology, gastroenterology, colorectal surgery, and neurology, which is why it is so often passed between specialties without resolution. Patients frequently arrive having had a laparoscopy, a cystoscopy, and a colonoscopy that were individually reassuring and collectively unhelpful.

What is commonly missed is the musculoskeletal and neural layer — the pudendal nerve, the sacroiliac joints, the coccyx, the sympathetic plexuses, and the pelvic floor musculature. Those are the contributors interventional pain medicine can address, and they are what we focus on, working alongside your existing specialists rather than replacing them.

Common Symptoms

Persistent pelvic, perineal, or groin pain
Pain with sitting or intercourse
Bladder, bowel, or pelvic-floor dysfunction
Pain after pelvic surgery or childbirth

Common Causes

Pudendal neuralgia
Sacroiliac joint dysfunction
Post-surgical nerve injury
Endometriosis-related neural sensitization
Coccydynia

Treatments at HTx Pain

How we approach pelvic pain.

Targeted Nerve Blocks

Pudendal, ganglion impar, and superior hypogastric plexus blocks.

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Spinal Cord Stimulation

Considered for chronic refractory pelvic pain.

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Diagnosis & workup

A detailed history including the distribution of pain, positional triggers such as sitting, and bladder, bowel, and sexual function.
Review of what has already been excluded by gynecology, urology, and gastroenterology.
Examination for pelvic floor tension, sacroiliac provocation, coccygeal tenderness, and pudendal nerve distribution.
Imaging directed at a specific question rather than used as a survey.
Diagnostic nerve or plexus block — pudendal, ganglion impar, or superior hypogastric — to confirm the pathway before treating it.

When to see a specialist

Pelvic, perineal, or groin pain persisting beyond six months without a clear explanation.
Pain that is markedly worse with sitting and eased by standing.
Pain that began after pelvic surgery, childbirth, or trauma.
A negative gynecologic, urologic, and gastrointestinal workup with pain that continues.
Pain that is limiting work, sleep, or intimacy.

Recovery & outlook

What to expect over time.

Pelvic pain usually improves in steps rather than all at once. A diagnostic block tells us whether the pathway we suspect is the right one, and that information is valuable even when the relief is temporary. Where a block confirms the source, relief can often be extended with a therapeutic version, and physical therapy does a substantial part of the work alongside it. For pain that remains refractory, spinal cord stimulation is considered and trialed for 5 to 7 days first, so you know whether it helps before anything is implanted. Progress here is measured in sitting tolerance, sleep, and function.

Common Questions

Direct answers — no jargon.

If your question isn’t here, ask us at your consultation.

Because the pelvis is shared territory, and each specialty reasonably excludes its own causes first. What often goes unexamined is the neural and musculoskeletal layer — the nerves, joints, and pelvic floor — which is where we start.

Why HTx Pain Institute

How we treat pelvic pain, differently.

Pelvic pain patients are, more than any other group we see, tired of being handed between specialties. Our role is narrow and specific: identify and treat the neural, joint, and musculoskeletal contributors, be clear about which parts of the problem belong elsewhere, and coordinate with the team you already have rather than compete with it.

Other conditions we treat.

See all conditions

Reviewed by Edward Baumgartner Jr., MD · Last reviewed September 10, 2026. Information on this page is not medical advice. Always consult your physician.

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Two Houston-area locations. Same-week consults available. Most insurance accepted.