Editorial note: This article began as an AI-generated draft prepared for the Endometriosis Awareness & Education Blog. It was clinically reviewed, edited where needed, and approved for publication by Dr Amena Shelleh.
Pelvic pain can have several contributing factors. Some people with endometriosis also have painful, overactive or poorly coordinated pelvic-floor muscles. If painful sex can be attributed to overactive pelvic-floor muscles in part, pelvic floor physiotherapy may be of some benefit. Pelvic health physiotherapy may be considered to assess and address these problems as part of a wider care plan. It does not diagnose endometriosis, remove lesions or replace medical treatment.
What Is Pelvic Physiotherapy?
A pelvic health physiotherapist assesses symptoms, movement and pelvic-floor function before suggesting treatment. Depending on the findings, care may include education, breathing and relaxation, movement, manual techniques or exercises. Pelvic-floor strengthening is not an automatic recommendation: repeated contractions may be unsuitable when muscles are already overactive or difficult to relax. Referral to a qualified practicing physiotherapist for pelvic floor physiotherapy may be a beneficial treatment where appropriate.
How Can Pelvic Physiotherapy Help with Endometriosis?
- Pelvic pain: Assessment can explore whether muscle tension or movement problems contribute to symptoms. Treatment may help some people, but improvement is not guaranteed.
- Bladder and bowel symptoms: These need appropriate assessment rather than an assumption that endometriosis or pelvic-floor dysfunction explains them. Physiotherapy may be considered if a relevant muscle problem is identified.
- Pain during sex: Pelvic-floor assessment may be useful when muscle problems contribute to discomfort. Treatment should respect your comfort, choices and consent.
- After surgery: Any rehabilitation should be agreed with your surgical team and tailored to recovery. Physiotherapy should not be described as a guaranteed way to resolve scarring or adhesions.
What to Expect in a Session
The first appointment usually begins with a discussion of your symptoms, history and priorities. An external examination may be suggested. An internal vaginal or rectal examination should only be offered when appropriate and with informed consent. You can decline an examination or ask for it to stop. The physiotherapist should explain the proposed treatment and agree a plan with you.
Evidence and Recommendations
Research into physiotherapy for endometriosis-related pain is encouraging, although the evidence is still limited. A 2023 review by Abril-Coello and colleagues, which included six studies, found that conservative treatments helped reduce pain and improved some aspects of physical functioning. However, the studies varied considerably in their approaches and results.
A more recent review by Can and colleagues, published online in 2025 and in a 2026 journal issue, also found that physiotherapy was associated with reduced pelvic pain. However, the studies used different techniques, and there is not yet enough evidence to determine which approaches work best or how long the benefits last.
The 2022 ESHRE endometriosis guideline concluded that there was insufficient evidence to recommend any one non-medical treatment, including physiotherapy, for endometriosis-related pain. Physiotherapy may nevertheless be helpful for some people, particularly those with pelvic-floor muscle tension or other musculoskeletal problems. It should be considered as part of an individualised treatment plan, rather than a proven treatment for everyone with endometriosis.
How to Find a Pelvic Physiotherapist
Ask your GP or gynaecology team about access to a qualified physiotherapist with experience in pelvic health and persistent pelvic pain. Discuss how any physiotherapy would fit alongside your existing endometriosis care.
References
- Abril-Coello R, Correyero-León M, Ceballos-Laita L, Jiménez-Barrio S. Benefits of physical therapy in improving quality of life and pain associated with endometriosis: a systematic review and meta-analysis. International Journal of Gynecology & Obstetrics. 2023;162(1):233–243. DOI: 10.1002/ijgo.14645.
- Can G and colleagues. Physiotherapy for endometriosis-associated pelvic pain: a systematic review and meta-analysis. Pain Medicine. 2026;27(1):95–103; first published online 24 July 2025. DOI: 10.1093/pm/pnaf083.
- ESHRE. Guideline on Endometriosis. 2022. Section on non-medical strategies for endometriosis-associated symptoms.
- Pelvic, Obstetric and Gynaecological Physiotherapy (POGP). Persistent pelvic pain and Physiotherapy assessment. General pelvic-health information, accessed 5 October 2026.
Sources checked on 5 October 2026.
Disclaimer
This article provides general education only. It is not a substitute for individual medical advice, diagnosis or treatment. Seek medical assessment for new, persistent or worsening pelvic pain.
