When Fertility Care Hurts: Pelvic Floor Dysfunction and Chronic Pelvic Pain in Infertility

Objective: To review the current literature regarding pelvic floor dysfunction and chronic pelvic pain in infertility patients and identify opportunities for multidisciplinary management within reproductive endocrinology and infertility (REI) care. Design: Narrative literature review and clinical gap analysis. Materials and Methods: A literature review was performed using PubMed, Embase, and Google Scholar to identify studies related to pelvic floor dysfunction, dyspareunia, vulvodynia, interstitial cystitis/bladder pain syndrome, chronic pelvic pain, and infertility care. Literature evaluating pelvic floor hypertonicity, sexual dysfunction, procedural tolerance, pelvic floor physical therapy, and multidisciplinary management strategies in reproductive-age patients was reviewed and synthesized. Results: Emerging literature suggests chronic pelvic pain and pelvic floor dysfunction may negatively affect intercourse frequency, fertility evaluation, tolerance of transvaginal ultrasonography, and overall patient experience during infertility treatment. Overlapping pain conditions, including endometriosis, vulvodynia, interstitial cystitis/bladder pain syndrome, irritable bowel syndrome, fibromyalgia, and myofascial pelvic pain, may contribute to delayed diagnosis, procedural intolerance, and fragmented care. Limited literature currently exists addressing routine screening and multidisciplinary management of pelvic floor dysfunction within REI practices. Multidisciplinary collaboration among REI specialists, urogynecologists, pelvic floor physical therapists, pain specialists, gastroenterologists, and mental health professionals represents a potential opportunity to improve patient-centered fertility care and quality of life. Conclusions: Pelvic floor dysfunction and chronic pelvic pain represent underrecognized contributors to patient burden in infertility care. Increased recognition and multidisciplinary approaches may improve reproductive care experiences and quality of life. Further research is needed to better characterize prevalence, clinical impact, and treatment outcomes in infertility populations.