New Pelvic Pain Unit at MIVI: a comprehensive approach to an all-too-normalized condition

Chronic pelvic pain affects millions of people. And yet, it remains one of the most underestimated, under-diagnosed and under-addressed conditions in routine clinical practice. Many patients have been suffering for months – or years – from pain that conditions their work, their rest and their sex life, without ever having received a real specialized assessment. Many professionals, for their part, find themselves without a clear referral pathway when conventional treatments fail to provide an answer.

At MIVI we have decided to take a concrete step to change that.

What do we mean by chronic pelvic pain?

We speak of chronic pelvic pain when pain in the pelvic area, perineum or genitals persists for more than three months, recurs frequently or significantly interferes with daily life. Its manifestations are varied: burning, pelvic pressure, pain on sitting, dyspareunia, urinary urgency, painful constipation, chronic prostatitis… symptoms that are often treated in isolation without addressing the underlying mechanism.

What often goes unnoticed by both patients and clinicians is that this pain rarely has a single cause. It can be muscular, neuropathic, visceral or a combination of several mechanisms. And that distinction completely changes the therapeutic approach.

The mechanisms of pelvic pain: why diagnosis of origin matters

Identifying the predominant mechanism is the first and most critical step in designing an effective treatment.

Myofascial pain (pelvic floor / perineum) Muscle hypertonicity, active trigger points and impaired motor control. It is the most frequent mechanism in clinical practice and, paradoxically, one of the most underdiagnosed. It is usually aggravated by stress, after pelvic surgery or after childbirth.

Neuropathic pain (pudendal nerve / pelvic nerves) Produces sensations of burning, stinging or electrical sensation. The classic pattern is worsening in sitting and improvement in recumbency or standing. It is related to irritation of the pudendal nerve or other pelvic nerves.

Visceral pain (gynecologic / urologic / digestive) Linked to entities such as endometriosis, adenomyosis, interstitial cystitis or irritable bowel syndrome. Frequently overlaps with the above mechanisms, complicating diagnosis if not evaluated comprehensively.

Mixed pain (multifactorial) In specialized consultation, the coexistence of several mechanisms is the rule, not the exception. Treating a single component without considering the others explains, to a large extent, partial results or relapse.

The MIVI approach model: stepwise, personalized and multidisciplinary.

MIVI’s Pelvic Pain Unit works on the basis of a structured protocol that adapts the therapeutic intensity to the real needs of each patient:

1. Education and active habits – basis of treatment in all profiles, with direct impact on pain perception and patient autonomy.
2. Personalized medical treatment – tailored to the predominant mechanism and individual clinical characteristics.
3. Specialized pelvic floor physiotherapy – an essential component in most cases, regardless of the primary cause.
4. Advanced interventional techniques – blocks, neuromodulation or other precision techniques when the case requires it and the patient has not responded to previous steps.

All this with a coordinated work between pain medicine, physiotherapy and specialties that each case requires. Not as parallel consultations, but as an integrated team from the first moment.

When to refer or consult with the unit?

For professionals: referral is indicated when pain has been present for more than three months, when it has not responded to conventional treatments, or when the clinical picture suggests an unaddressed neuropathic or myofascial component. Early diagnosis significantly reduces the risk of chronification.

For patients: if the pain interferes with your work, your rest or your sex life, if it recurs frequently or if you simply feel that you have never received a clear answer to what is happening to you, it deserves a specialized assessment. It’s not something you should just put up with.

Warning signs requiring priority attention: fever or suspected infection, abnormal vaginal bleeding, hematuria, unexplained weight loss or sudden onset of severe pain with vegetative cortex.

The goal is not just to reduce pain. It is to restore life.

The evidence is clear: the earlier the pelvic floor component is addressed and the actual mechanism identified, the lower the likelihood of chronification and the greater the response to treatment. Structured follow-up makes a difference.

MIVI’s Pelvic Pain Unit is already in operation in two centers:

MIVI Barcelona Aliaga Institute

MIVI Manresa

If you have doubts about whether a case fits in our unit, do not hesitate to contact us. We are here to build together with you the model of care that these patients deserve.

MIVI – My life without pain.