Pelvic tenderness is a sensation of pain or discomfort that is felt in the pelvic region when the affected area is touched. The tendernes can arise due to various underlying conditions that cause irritation of pelvic organs and structures. Strenuous activity by itself can lead to mechanical trauma of pelvic structures and cause pelvic tenderness. Other common causes include inflammation or injury of the pelvic organs, or abcesses present in the pelvis. Pelvic tenderness is also strongly associated with pelvic pain. Individuals suffering from painful affections of the pelvis are much more prone to experience pelvic tenderness.

Pelvic tenderness may be associated with several diseases including:

Kidney stones

Kidney stones (Pic. 1) occur when salts in the urine form a solid crystal. These stones can block the flow of urine and cause infection, kidney damage or even kidney failure. The risk of kidney stones is about one in 10 for men and one in 35 for women. Kidney stones can range in size from a grain of sand to a pearl or even larger. They can be smooth or jagged, and are usually yellow or brown. A large stone may get stuck in the urinary system. This can block the flow of urine and cause great pain. Smaller stones can irritate the wall of the urinary tract with their movement and may simultaneously cause pain and pelvic tenderness.

Pelvic inflammatory disease

Pelvic inflammatory disease (Pic. 2) or pelvic inflammatory disorder (PID) is an infection of the upper part of the female reproductive system namely the uterus, fallopian tubes, or the ovaries. Around 2% of women are affected. The main complication is the formation of a pyosalpinx (abscess) and ectopic pregnancy is 6 times more likely after a pelvic infection. Often there may be no symptoms. Signs and symptoms, when present, may include pelvic tenderness, lower abdominal pain, vaginal discharge, fever, burning with urination, pain with sex, or irregular menstruation. Untreated PID can result in long term complications including infertility, ectopic pregnancy, chronic pelvic pain, and cancer. 

Vaginal infection

Infections of the vagina may cause redness, itching and irritation of the genital and perineal areas, as well as general pelvic tenderness. Bacterial vaginosis, Trichomonas vaginalis, and Candida albicans are the most prevalent bacterial, protozoan, and fungal causes of lower genital tract infections. A woman may have vaginal itching or burning and may notice a discharge. The discharge may be excessive in amounts or abnormal in color (such as yellow, gray, or green). 

Ovarian cysts

An ovarian cyst is a fluid-filled sac within the ovary (Pic. 3). Often they cause no symptoms. Occasionally they may produce bloating, lower abdominal pain, or lower back pain. One of the possible symptoms can be pelvic pain and tenderness, associated with menstruation and/or sexual intercourse.

Pelvic adhesions

Adhesions are bands of scar tissue (Pic. 4) that connect normally separated pelvic structures. Postoperative adhesions occur in 60% to 90% of patients undergoing major gynecologic surgery. Pelvic adhesions (scars) develop as a normal tissue response to inflammation, which occurs whenever the tissue is damaged. Adhesions are a frequent cause of infertility and pelvic pain in women. Pelvic adhesions impair fertility by disrupting normal tubal-ovarian relationships.

Chronic prostatitis

Prostatitis is a poorly defined condition and is shown to have a bacterial aetiology in 5 to 10% of cases. In the remaining proportion, the symptoms are attributed to “chronic non-bacterial prostatitis” or “chronic prostatitis/chronic pelvic pain syndrome. Pelvic tenderness has not been investigated in normal men. In chronic prostatitis/chronic pelvic pain syndrome, tenderness of the prostate is often present, however its relationship to prostatic inflammation has not been investigated. Whether pain is localized to the prostate or is part of a more generalized tenderness has not been determined.


The role of Endoscopy in Management of Infertility ―by Daru and Kereszturi licensed under CC BY 3.0
Pelvic inflammatory disease ―sourced from Fertilitypedia licensed under CC BY-SA 4.0
Vaginitis ―sourced from Wikipedia licensed under CC BY-SA 3.0
PELVIC INFLAMMATORY DISEASE ―sourced from licensed under CC BY- SA 4.0
Ovarian cysts ―sourced from Fertilitypedia licensed under CC BY-SA 4.0
Kidney Stones ―sourced from Queensland Government licensed under CC BY 3.0 AU
Kidney stones ―by BruceBlaus licensed under CC BY 3.0
Pelvic Inflammatory disease with bacteria ―by BruceBlaus licensed under CC BY 3.0
Ovarian cyst ―by James Heilman, MD licensed under CC BY-SA 3.0
Adhesions ―by Hic et nunc licensed under CC BY-SA 3.0
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