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Pelvic Pain Management
Chronic pelvic pain deserves a different kind of care.
Specialist interventional treatment for chronic pelvic pain — image-guided procedures, coordinated medical management, and a comprehensive approach that addresses the nerve, muscle, and central nervous system contributions to your pain.
Our Specialized Approach
Chronic pelvic pain is rarely caused by a single thing. It is almost always multimechanism — peripheral nerves, pelvic floor muscles, central sensitization, and sometimes hormonal contributions all layered together. Curious why chronic pelvic pain goes unrecognized for so long? Read our article: Why So Many Doctors Miss Chronic Pelvic Pain →
Treating only one mechanism is why so many patients see limited improvement with single-modality care. Our approach systematically addresses each contributor. Dr. Chaturani Ranasinghe, MD, is a double board-certified anesthesiologist and interventional pain physician. She received specialized training in pelvic pain from Dr. Robert Echenberg, a national leader in the field. The treatment toolkit below reflects that combined interventional + pelvic-specialist training.
Interventional Procedures We Offer
Image-Guided Trigger Point Injections of the Pelvic Floor
Targeted injection of local anesthetic — sometimes with corticosteroid — into specific tight, painful pelvic floor muscle bands. Provides meaningful relief for hypertonic pelvic floor dysfunction and reduces the muscular component of chronic pelvic pain.
Pudendal Nerve Blocks
Image-guided injection of local anesthetic — sometimes with steroid — to the pudendal nerve. Both diagnostic (confirms pudendal involvement) and therapeutic (reduces pudendal nerve pain). Performed under fluoroscopic or ultrasound guidance for precision. Learn more about pudendal neuralgia →
Ganglion Impar Blocks
Injection at the small sympathetic ganglion at the base of the sacrum. Particularly useful for coccygeal pain, perineal pain, and sympathetically-mediated chronic pelvic pain. Image-guided for safety and accuracy.
Botulinum Toxin Injection for Refractory Pelvic Floor Spasm
In selected patients with severe hypertonic pelvic floor dysfunction that has not responded to physical therapy and other treatments, targeted botulinum toxin injection can provide significant, longer-lasting relief by reducing the chronic muscle contraction.
Other Targeted Nerve Blocks
Including ilioinguinal, iliohypogastric, and genitofemoral nerve blocks for specific neuropathic pelvic pain patterns. Choice of block depends on your specific pain distribution and history.
Coordinated Care Beyond Procedures
Coordination with skilled pelvic floor physical therapists in the Naples / Marco Island area — pelvic floor PT is the cornerstone of long-term recovery for most pelvic pain patients.
Nerve-modulating medications (gabapentin, pregabalin, low-dose tricyclics, duloxetine) prescribed and managed by us when appropriate.
Hormonal evaluation when local hormonal contributions to pelvic tissue health are suspected.
Central sensitization treatment for patients with longstanding pain, where the nervous system has become its own driver of symptoms.
Coordination with gynecology, urology, gastroenterology, and surgical colleagues when other specialists need to be involved.
What to Expect at Your Consultation
Your first visit is a careful, unhurried evaluation. We take a thorough history — what your pain feels like, what makes it better or worse, what has been tried before, and what your specific goals are. The exam is gentle, fully explained in advance, and can be paused at any point. We review any prior imaging and treatment records you bring. Together, we build a treatment plan that fits your specific situation. This may include one or more of the interventional procedures above, a coordinated PT referral, medication adjustments, and a clear timeline of what to expect. We talk through expectations, possible side effects, and what success looks like for you. Follow-up is typically at two to four weeks to assess response and refine the plan. Chronic pelvic pain treatment is usually iterative — we adjust as we learn how your pain responds.
To learn about the specific pelvic conditions we treat — vulvodynia, pudendal neuralgia, interstitial cystitis, endometriosis-related pelvic pain, and pelvic floor dysfunction — see our Chronic Pelvic Pain Conditions hub →
