A Scoping Review of Interdisciplinary Care Programs for Women With Persistent Pelvic Pain

ABSTRACT

Background and Objective

Persistent pelvic pain affects one in four women, with international guidelines recommending interdisciplinary care. However, much of the literature describing treatments for pelvic pain focus on the perspective of individual professions. This narrative scoping review aimed to increase understanding of interdisciplinary pelvic pain care in terms of the professions and treatment components included, coordination of care and the inclusion of people with lived experience (PWLE) in program development.

Databases and Data Treatment

Guided by PRISMA guidelines for scoping reviews, systematic database searches were conducted in CINAHL, Scopus, Medline and PsychINFO to identify interdisciplinary programs for women with persistent pelvic pain, including pelvic pain diagnoses such as endometriosis, vulvodynia and painful bladder syndrome. Data were charted on number and type of professions (disciplines) included, treatment components, care organisation and coordination, and PWLE involvement.

Results

The search yielded 1068 records; 69 full‐text articles were reviewed, and 16 studies were eligible for inclusion. Commonly included professions were physiotherapy, psychology and gynaecology. Treatment components included assessment, education and pain management strategies. Information pertaining to the coordination of care between professions and the engagement of PWLE in program development was limited.

Conclusion

This review found significant variation in the structure and components of interdisciplinary pelvic pain care programs, emphasising the need for greater consistency in their development and implementation. Further empirical research is needed to evaluate the effectiveness of specific program components. Enhanced coordination among professions and increased involvement of PWLE in program design are also recommended.

Significance Statement

This scoping review found wide variability in the processes of interdisciplinary pelvic pain care for women. Professions most frequently included were pelvic physiotherapy, psychology and gynaecology, and components most consistently included were assessment, education and pain management strategies. Coordination of care was poorly described, and people with lived experience (PWLE) were rarely involved in program development. Findings highlight the need for greater inclusion of PWLE in program design, and greater standardisation of interdisciplinary care so that outcomes can be evaluated.

1. Introduction

Persistent pelvic pain refers to pain below the umbilicus and between the hips that lasts for more than 3 months (Jarrell et al. 2018). The estimated worldwide prevalence in females is approximately 24% (Reavey and Vincent 2022). Associated diagnoses include endometriosis, adenomyosis, vulvodynia, painful bladder syndrome and genito‐pelvic pain/penetration disorder (Lamvu et al. 2021). Causes and contributors are multifactorial, involving physical, psychological and social factors (Allaire et al. 2018). Persistent pelvic pain impacts multiple health‐related quality of life domains, including work, relationships, physical, psychological and sexual wellbeing and self‐concept (Chalmers et al. 2017; Kalfas et al. 2022; Van Niekerk et al. 2022), and is considered a whole of person condition (Evans, Olive, et al. 2022).

Despite the emphasis on interdisciplinary care and the involvement of PWLE in program development, (Australian Government 2018; Fang et al. 2024), there is limited knowledge on their incorporation into clinical practice. Interdisciplinary care involves several professions working collaboratively to improve patient outcomes (RANZCOG 2021). However, in persistent pelvic pain, multidisciplinary care models are more common, where professions work in parallel rather than as an integrated team. Codesign approaches that include PWLE are considered best practice for developing health interventions (Sherman et al. 2022). Codesign is recommended to enhance patient‐centered care (Armour et al. 2023; Dancet et al. 2023), and is increasingly used in pain management (Webber et al. 2020, 2022) and women's health (Blewitt et al. 2022).

Pelvic pain guidelines recommend interdisciplinary management (Arnold et al. 2021; Engeler et al. 2023; Ghai et al. 2021), by medical, surgical, physiotherapeutic and psychological professions, with a focus on symptom management, fertility preservation, self‐management and education (Lamvu et al. 2021). Nutrition and complementary therapies have also been described (Evans, Villegas, et al. 2022; Gutke et al. 2021; Malik et al. 2022) though not endorsed by pelvic pain guidelines. Interdisciplinary pelvic pain care is a new area of practice, with limited consensus regarding the process of interdisciplinary care and limited published evidence of outcomes. Understanding of which professions and disciplines are included, how care is coordinated, and core program inclusions is lacking, with published studies frequently reporting on single‐discipline or single‐profession programs (Brooks et al. 2021; Schubert et al. 2024). To address these gaps, a scoping review was considered appropriate.

Scoping reviews are often used when there is limited empirical evidence in a field. They follow a systematic approach to map evidence on a topic; identify key characteristics or factors related to a concept; and determine where the gaps are (Peters 2016; Peters et al. 2015; Tricco et al. 2018). This scoping review aimed to provide a descriptive synthesis of interdisciplinary pelvic pain care programs for women and gender‐diverse individuals, presumed female at birth. Our objective was to answer the following questions: (1) which professions are included in interdisciplinary programs? (2) what specific components are included in interdisciplinary programs? (3) how is interdisciplinary care organised and coordinated? and (4) are people with lived experience (PWLE) involved in the development and refinement of interdisciplinary programs?

2. Literature Search Methods

A protocol was developed based on the scoping review methodology outlined by Peters et al. (2020) and Pollock et al. (2023) and registered in the Open Science Framework platform (https://osf.io/7taen/). Findings are reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses extension for scoping reviews (PRISMA‐ScR) checklist and guidelines (Tricco et al. 2018). This scoping review included primary peer‐reviewed studies published in English, including trials, case studies, observational studies and other descriptive studies reporting interdisciplinary persistent pelvic pain programs. Conference abstracts, reviews and grey literature were not included.

2.1. Inclusion and Exclusion Criteria

The inclusion criteria were derived using the ‘Population’, ‘Concept’ and ‘Context’ framework for scoping reviews (Pollock et al. 2023).

2.1.1. Population

Eligible studies included those with women or gender‐diverse individuals (presumed female at birth), aged 18 years or older, who had a diagnosis of persistent or chronic pelvic pain for at least 3 months. Various pelvic pain diagnoses were considered, such as endometriosis, adenomyosis, painful bladder syndrome, dyspareunia, vaginismus, genito‐pelvic pain and penetration disorder and vulvodynia. Studies focusing solely on adolescents, pregnancy or cancer were excluded. Additionally, studies with participants of all genders were included only if the gender distribution was reported.

2.1.2. Concept

The key concept examined in this scoping review was interdisciplinary care. Eligible studies were those that reported programs provided by at least two different healthcare professions, such as medical, surgical, allied health (e.g., psychology, physiotherapy) and nursing. Studies that included only doctors from medical or surgical specialties (e.g., gynaecology, urology, general medical practitioners) were excluded unless at least one other health profession was also involved.

2.1.3. Context

The included studies encompassed a range of care settings, including acute, primary and community care. They also covered various healthcare funding models (government and private), geographical locations, models of care (e.g., gynaecology‐led services, pain management services) and healthcare professions and disciplines (e.g., medical, surgical, psychology, physiotherapy).

2.2. Search Strategy

The search strategy was formulated by the research team and an academic research librarian at the University of Tasmania (see Table S1). Preliminary search strategies explored the use of search terms for specific pelvic pain diagnoses (e.g., vulvodynia, painful bladder syndrome, interstitial cystitis, vaginismus, dyspareunia, genito‐pelvic pain and penetration disorder). However, this did not result in any additional inclusion or exclusion of manuscripts compared to the use of variations of the term “pelvic pain”. Our search strategy sufficiently captured specific pelvic pain diagnoses such as vulvodynia and painful bladder syndrome and was noted to be consistent with other recent scoping reviews of persistent (or chronic) pelvic pain conditions (Brooks et al. 2020; Panisch and Tam 2020).

Combinations of the following search terms were used: (persistent pelvic pain OR chronic pelvic pain OR pelvic pain OR endometriosis and chronic pain OR endometriosis and pelvic pain) AND (multidisciplinary OR interdisciplinary OR non‐pharmacological OR multimodal OR allied health OR pain management) AND (women OR woman OR female OR transgender OR nonbinary OR gender diverse). A complete search strategy for one database is shown in Table S2. Medline (Ovid), CINAHL (Ebsco), PsychInfo (Ovid) and Scopus (Elsevier) were searched on 23–29 June 2023 for relevant articles published in the preceding 10 years.

2.3. Study Selection

Results from all searches were imported into Covidence systematic review software (Veritas Health Innovation, Melbourne, Australia, 2024, available at www.covidence.org) and duplicates removed. Two independent reviewers (CA, LVN) screened all titles and abstracts. Duplicates and articles that unequivocally did not meet the eligibility criteria were removed. Articles that unequivocally met or potentially met the inclusion criteria were independently screened in full‐text form by two researchers (CA, LVN). Consensus was reached via discussion to determine suitability for inclusion.

2.4. Data Charting and Synthesis

A data extraction form was developed and refined by two researchers (CA, LVN) to extract data items relevant to the objectives of this scoping review. We extracted the following data, where available, from each study's report: (a) study characteristics (author, year, country, type of care setting, study type); (b) participant characteristics (sample size, age, gender, duration of pain, pain intensity, comorbidities, pelvic pain diagnoses); (c) interdisciplinary program characteristics (professions/disciplines included, organisation and coordination of care, program parameters, program content and inclusions). Preliminary data extraction was done by one researcher (CA) using Covidence systematic review software, then two researchers (CA, LVN) discussed and decided on the format for developed data tables in Word (Microsoft Corp., Redmond, WA, USA). A narrative summary organised around the four research questions is used to report the results of this scoping review.

3. Results

Database searches identified 1522 manuscripts. After duplicates were removed, 1068 reports remained. Title and abstract screening eliminated 999 of those reports, leaving 69 reports for full text screen. After full text screening, 16 studies met the inclusion criteria and were included for final data extraction. The study selection process is illustrated in the PRISMA‐ScR flow chart (see Figure 1).

FIGURE 1.

PRISMA‐ScR flowchart of study selection Page et al. 2021.

3.1. Characteristics of Included Studies

As seen in Table 1, studies took place in the United States of America (n = 7), Canada (n = 3), Europe: Italy, Germany, Spain, Netherlands (n = 4) and the United Kingdom (n = 2). Most studies took place in tertiary care settings (n = 14), within pain management services (n = 4), endometriosis and/or pelvic pain services (n = 7), or within specialist medically led services: gynaecology, urology, physical medicine and rehabilitation services (n = 3). One study was community based (Kreher et al. 2023) and one study took place within a number of private medically led pelvic rehabilitation clinics (Shrikhande et al. 2023).

TABLE 1.

Overview of general study characteristics.

Author/publication year	Country/setting/timeframe	Study type/participant demographics	Pelvic pain diagnoses
Aboussouan et al. 2021	USA: Tertiary pain service (Cleveland Clinic: Interdisciplinary chronic pain rehabilitation program) 2011–2015	Case control study Females (n = 58) with CPP and impaired sexual function, mean age of 43 years, mean pain duration of 13 years, 90% of sample have comorbid pain diagnoses, mean pain level 7/10, pelvic pain diagnosis confirmed by pain management physician. Information pertaining to gender diversity not reported in manuscript	Interstitial cystitis, pelvic floor pain, endometriosis, visceral hyperalgesia, dyspareunia, vaginismus, vulvodynia, groin pain sacroiliitis, pelvic congestion syndrome, nonspecific pelvic pain
Abraham et al. 2019	USA: Tertiary physical medicine and rehabilitation service (University of Texas Southwestern Medical Centre) 2010–2015	Retrospective chart review Females (n = 37) with residual pelvic pain or dyspareunia following mesh sling placement for the treatment of stress urinary incontinence and/or pelvic organ prolapse (and subsequent mesh removal), mean age of 54 years, median pain duration 4 years, comorbidities (urinary incontinence, voiding dysfunction), mean pain level of 6/10, diagnostic confirmation not reported. Information pertaining to gender diversity not reported in manuscript	Residual pelvic pain or dyspareunia after synthetic vaginal mesh and/or mesh sling removal
Agarwal et al. 2019	USA: Tertiary endometriosis research and treatment service (University of California, San Diego) 2010–2019	Descriptive study Females with endometriosis or suspected endometriosis referred to CERT. Information pertaining to participant age, pain duration, pain levels, comorbid diagnoses, and gender diversity not reported as manuscript is descriptive only	Endometriosis
Allaire et al. 2018	Canada: Tertiary pelvic pain and endometriosis service (British Columbia Women's Center for Pelvic Pain and Endometriosis) 2013–2014	Cohort study Females with CPP, endometriosis, suspected endometriosis referred to the Centre (n = 296), mean age of 34 years, median pain duration of 13 years, median of two comorbid diagnoses, mean pain level of 6/10, endometriosis diagnosis surgically or clinically confirmed. Information pertaining to gender diversity not reported in manuscript	Endometriosis, abdominal wall pain, pelvic floor myalgia, painful bladder syndrome
Ariza‐Mateos et al. 2020	Spain: Tertiary gynaecology service (University Hospital of Granada) 2018–2019	Randomised controlled trial Females with CPP and significantly impaired function at home or at work (n = 44), mean age of 43 years, mean pain duration of 7 years, mean pain level of 7/10, pelvic pain diagnosis confirmed by gynaecologist. Information pertaining to comorbid diagnoses and gender diversity not reported in manuscript	Chronic pelvic pain
Boersen et al. 2021	Netherlands: Three tertiary endometriosis services (Rijnstate Hospital, Radboud University Medical Centre, and Catharina Hospital) 2019–2021	Randomised controlled trial Females with endometriosis, aged 18–50 years, pain rating reported as a minimum of 4/10, endometriosis diagnosis surgically or clinically confirmed. Study describes a protocol for a randomised controlled trial, therefore data not provided	Endometriosis
Brünahl et al. 2018	Germany: Tertiary CPP clinic (University Medical Centre Hamburg‐Eppendorf) 2012–2017	Non‐randomised controlled feasibility study Male and female participants (n = 36, 53% female) with CPP, mean age of 49 years, mean pain duration of 6 years, multimodal diagnostic confirmation (EUA guidelines). Information pertaining to comorbidity, mean pain level, and gender diversity not reported in manuscript	Chronic pelvic pain syndrome
Centemero et al. 2021	Italy: Tertiary urology service (San Raffaele Hospital, Milan) 2016–2019	Cohort study Male (n = 11) and female (n = 79) participants with CPP, mean age of 40 years, clinical diagnostic confirmation. Information pertaining to comorbidity, mean pain level, mean pain duration and gender diversity not reported in manuscript	Urological pain syndromes, interstitial cystitis, bladder pain syndrome, prostatodynia
Edwards et al. 2020	UK: Tertiary pain service with a CPP program (Pain Management Centre, National Hospital for Neurology and Neurosurgery, London) 2008–2017	Mixed methods: Program development and cohort study Male (n = 92) and female (n = 281) participants with CPP, mean age of 44 years, mean pain duration of 10 years, clinical pelvic pain diagnosis. Information pertaining to mean pain level, comorbidity and gender diversity not reported in manuscript	Chronic pelvic pain, endometriosis, pudendal neuralgia, bladder pain syndrome, vulval pain syndrome
Katz et al. 2021	Canada: Tertiary pain service with a CPP program (Michael G. DeGroote Pain Clinic, Hamilton Health Services, McMaster University Medical Centre) 2017–2019	Cohort study Females with CPP (n = 37), mean age 41 years, mean pain duration 10 years, comorbidities (irritable bowel syndrome, inflammatory bowel disease, fibromyalgia), pelvic pain diagnoses clinically confirmed. Information pertaining mean pain level and gender diversity not reported in manuscript	Endometriosis, irritable bowel syndrome, adenomyosis, bladder pain syndrome, urinary symptoms, dyspareunia, GPPPD
Kreher et al. 2023	USA: Community based education program developed by a tertiary CPP service (University of Rochester, Center for Chronic Pelvic and Vulvar Pain). 2017–2021	Needs assessment and descriptive case report Participants with CPP (n = 64), mean age of 35 years, mean pain level 5/10. Information pertaining to mean pain duration, diagnostic confirmation, and comorbidity not reported in manuscript 98% of sample cisgender women, gender of remaining 2% not reported	Chronic pelvic pain, endometriosis
Opoku‐Anane et al. 2020	USA: Tertiary endometriosis and CPP service (University of California San Francisco) 2016–2018	Descriptive study No demographic details provided as manuscript is descriptive only	Endometriosis, chronic pelvic pain
Shrikhande et al. 2023	USA: Private rehabilitation clinics (Pelvic Rehabilitation Medicine) 2020–2021	Retrospective chart audit Females (n = 60) with endometriosis, mean age 42 years, average pain duration 9 years, average pain level 7/10, comorbidities (fibroids, migraines, temporomandibular joint disorder), diagnosis surgically confirmed. Information pertaining to gender diversity not reported in manuscript	Endometriosis, chronic pelvic pain
Twiddy et al. 2015	UK: Tertiary pain service with a CPP program (Walton Centre, Liverpool, commissioned by National Health Service England) 2014	Feasibility study Females (n = 9) with CPP, mean age 30 years. Information pertaining to mean pain level, mean pain duration, diagnostic confirmation, comorbidity, and gender diversity not reported in manuscript	Chronic pelvic pain
Westbay et al. 2021	USA: Tertiary CPP clinic (Loyola and Rush University Medical Centres) 2012–2017	Cohort study Females (n = 317), mean age 44 years, median pain duration 3 years, mean pain score 6/10, clinical diagnostic confirmation, comorbidities (musculoskeletal pain, fibromyalgia, irritable bowel syndrome). Information pertaining gender diversity not reported in manuscript	Chronic pelvic pain, pelvic floor myofascial pain, painful bladder syndrome, endometriosis, vulvodynia
Yong et al. 2018	Canada: Tertiary pelvic pain and endometriosis service (British Columbia Women's Center for Pelvic Pain and Endometriosis) 2013–2014	Cohort study Females (n = 278) with deep dyspareunia, median age 34 years, clinical diagnostic confirmation by gynaecologist, comorbidities (irritable bowel syndrome). Information pertaining to mean pain duration, mean pain score and gender diversity not reported in manuscript	Deep dyspareunia, endometriosis, painful bladder syndrome

Abbreviations: CPP, Chronic pelvic pain; EUA, European Urology Association; GPPPD, Genitopelvic pain and penetration disorder.

As seen in Table 1, various study types were included (cohort studies, descriptive studies, randomised controlled trials, feasibility studies, retrospective audits). Since the focus of this scoping review was on components of interdisciplinary care, rather than effectiveness, outcome data was not extracted. Most programs focused solely on women (n = 11), three programs included both females and males (Brünahl et al. 2018; Centemero et al. 2021; Edwards et al. 2020), and only one program reported gender diversity information (e.g., non‐binary, transgender male) (Kreher et al. 2023), although full details were not provided.

The average participant age was 41 years (n = 13 programs), with an average pelvic pain duration of 8 years (n = 9 programs) and a pain level of 6 out of 10 (0 = No pain, 10 = Worse pain; n = 8 programs). Pelvic pain diagnoses included conditions such as endometriosis, adenomyosis, painful bladder syndrome, vulvodynia, dyspareunia, pelvic congestion syndrome and genito‐pelvic pain and penetration disorder (see Table 1), with endometriosis being the most common. Physical comorbidities reported included irritable bowel syndrome, fibromyalgia and migraines, and comorbid psychological symptoms included depressed mood, anxiety and trauma, with limited information presented regarding formal psychiatric comorbidity or diagnoses (See Table 1).

3.2. Which Professions Are Included in Interdisciplinary Programs?

The median number of professions per program was 3 (range 2–7), with the most reported professions being physiotherapy (n = 14 programs), psychology (n = 12 programs), and gynaecology (n = 8) (Table 2). A quarter of programs included social work, occupational therapy or nursing (n = 4, see Table 2). Reported nursing roles included patient support (Boersen et al. 2021), care coordination and overseeing the patient experience (Agarwal et al. 2019). One study described a patient navigator (profession not specified), whose role was to function as a single point of contact to coordinate referrals and appointment scheduling across multiple departments both within and external to the service (Opoku‐Anane et al. 2020). Less commonly reported were dietetics, pharmacy, exercise physiology and complementary therapies (e.g., acupuncture). Many studies offered limited information on the specific qualifications, training, or experience of the practitioners relevant to pelvic pain management (see Table 2). Exceptions included Centemero et al. (2021) that reported all team members having at least 10 years' experience in the treatment of chronic pelvic pain, Twiddy et al. (2015) that reported all team members having a special interest and training in chronic pelvic pain, and Boersen et al. (2021) that reported all team members having extensive experience in treating women with endometriosis. Additionally, most studies including physiotherapy (n = 12/14) described specific expertise, training or experience in pelvic physiotherapy or pelvic floor physical therapy and sometimes pain management. Psychologists were sometimes reported as having training and experience in chronic pain, endometriosis, sexual health, pain management, psychotherapy and psychosexual therapy (Boersen et al. 2021; Twiddy et al. 2015).

TABLE 2.

Interdisciplinary program characteristics.

Author/year	Professions (disciplines) included/training in pelvic pain	Organisation and coordination of care	Program parameters	Program content/inclusions
Aboussouan et al. 2021	Pain medicine (physician), *psychology, *physical therapy, *occupational therapy	Pain management program Central profession: Doctor (pain physician) Coordination: No information provided	In‐person group, in‐person individual, 8.5 h per day × 15–20 days	Assessment: Diagnosis by pain management physician. Inclusions: Psychoeducation, functional restoration, psychotherapy, pelvic floor physiotherapy, medication management, optional monthly aftercare
Abraham et al. 2019	Physiatry (physical medicine and rehabilitation physician specialising in pelvic floor rehabilitation medicine), physical therapy (certification in pelvic physical therapy)	Medically led care Central profession: Doctor (physiatrist) Coordination: No information provided	In‐person individual, physiotherapy sessions n = 2–11, medical sessions n = 1–5	Assessment: Patient history and physical examination by physiatrist. Inclusions: Physical therapy: Individualised plan, education, RT, pelvic floor relaxation, dilator therapy, breath control training, EMT, IMT (lidocaine jelly). Physiatrist: Medication/injection review (e.g., CT‐guided perineural and/or intramuscular piriformis injections, psychotherapeutic medications, muscle relaxants)
Agarwal et al. 2019	Gynaecology, primary medical care practitioner, *integrative medicine (acupuncture, nutrition, mind–body programs), *mental health practitioners (including psychology), pelvic physical therapy, *nursing, community support group	Medically led care Central profession: Doctor (gynaecologist) Coordination: Patient‐centred with gynaecologist, nursing staff help coordinate care and oversee patient experience	Not reported	Assessment: Patient history, needs assessment, collaborative care planning by gynaecologist. Referral to other professions (disciplines) initiated Inclusions: Education, integrative medicine (decreasing inflammation), psychological wellbeing, psychiatric referral, medication management, pain medicine consultation for non‐endometriosis related pain, physical therapy for dyspareunia and pelvic floor dysfunction, IMT
Allaire et al. 2018	Gynaecology, physical therapy, *counselling	Medically led care Central profession: Doctor (gynaecologist) Coordination: No information provided	In‐person individual, in‐person group, mean physical therapy and counselling sessions = 2	Assessment: Collaborative care planning by gynaecologist. referral and treatment pathway initiated. Inclusions: Minimally invasive surgery, medication management, group pain education, individualised physical therapy & counselling. Physical therapy: Breath control training, activity management, RT, MT, strengthening, bladder/bowel training. Counselling: Mindfulness‐based strategies, breath control training, RT, PMR, CBT. Pain education workshop: Validation, multifactorial contributors to chronic pelvic pain, sensitisation
Ariza‐Mateos et al. 2020	Physical therapy and occupational therapy (education in pain management and > 7 years experience in chronic pain management)	Pain management program. Central profession: No information provided Coordination: No information provided	In‐person individual, 6 × 45‐min session, weekly	Assessment: Quality of life, coping behaviours, pain severity, physical activity, occupational performance, psychological wellbeing. Inclusions: Education, coping, self‐management, goal setting, activity management, graded exposure, action plans, practice, supported behaviour change
Boersen et al. 2021	Gynaecology, psychology (experience in CBT, chronic pain, endometriosis), nursing (endometriosis nurse)	Pain management program. Central profession: Psychologist Coordination: No information provided	In‐person hybrid group program, in‐person telehealth, 7× fortnightly sessions (1 pre‐surgery, 2–6 weeks post‐surgery)	Assessment: All participants assessed by gynaecologist as requiring surgery Inclusions: Surgery, CBT (therapeutic compliance, endometriosis‐related impacts, surgical expectations, pain education, therapy goals, pain and behaviour), RT, pain and emotion, pain and cognitions, pain hypervigilance, intimacy and sexuality, relapse prevention
Brünahl et al. 2018	*Physiotherapy, *psychotherapy	Pain management program. Central profession: No information provided Coordination: No information provided	In‐person individual, in‐person group, 22‐week program, physiotherapy (6 × 1 h, 3 × 1.5 h), CBT (9 × 1.5 h).	Assessment: multimodal diagnostic algorithm (psychosomatic, physiotherapeutic, urologic, gynaecological). Physiotherapy: Education, heat, MT, therapeutic movement, active exercises, self‐management strategies. CBT: Theory, group discussion, PMR, behaviour analysis, positive self‐messages, fear avoidance beliefs AND behaviour, behaviour activation, coping strategies, catastrophizing cognitions, social supports.
Centemero et al. 2021	Urogynecology, psychology, physiotherapy. Team members have at least 10 years' experience in chronic pelvic pain treatment Psychiatry and neurology “on demand”	Medically led care Central profession: Doctor (urogynaecologist) Coordination: Team coordinator role, monthly MDT meeting	In‐person, 10× weekly sessions	Assessment: Clinical evaluation, physical exam, treatment motivation. Inclusions: Weekly bladder instillation with dimethyl sulfoxide (DMSO), kinesiotherapy, Percutaneous Tibial Nerve Stimulation, Stanford Protocol (pelvic floor relaxation), dietary protocol. Psychological input not reported
Edwards et al. 2020	*Pelvic physiotherapy, *clinical psychology	Pain management program Central profession: No information provided Coordination: No information provided	In‐person group, 7× weekly sessions. Session duration not reported	Assessment: Biopsychosocial assessment Inclusions: Multidisciplinary pelvic pain management program with specific content for improving intimacy and sexual relationships. Topics include pain education; attentional focus & mindfulness; sensate focus; avoidance reduction; desensitisation; flare up management; communication strategies; medication management; intimacy; sexual activity; relationships; bladder and bowel urgency/frequency; emotions; fertility; noticing and addressing anxiety, hypervigilance, fear, which are known to influence muscle tension Pelvic floor physical therapy: self‐management strategies, movement with awareness, pelvic floor relaxation, desensitisation
Katz et al. 2021	*Psychology, pelvic floor physiotherapy, *pharmacy, *dietetics, *occupational therapy, *social work. All female team	Pain management program Central profession: No information provided Coordination: No information provided	In‐person group program, 3 h × 8 weekly sessions. 6–8 females, closed group	Assessment: Interdisciplinary (psychologist, pelvic floor physiotherapist). Inclusions: Self‐management, mood and anxiety management, pain de‐catastrophizing, chronic pain & stress/trauma, regulation strategies. Physiotherapy: Cardiovascular, stretching, strengthening exercises, body/pelvic floor awareness, trigger point release techniques, skin rolling techniques, breath control training. Psychoeducation: Pain science, sleep, flare‐ups, pacing and activity, emotion regulation, communication, sexual intimacy, anti‐inflammatory diet
Kreher et al. 2023	Gynaecology, family physician (sexual wellness), physical therapy (pelvic health), *clinical psychology, dietetics (registered dietitian), exercise specialist	Pain management program Central profession: No information provided Coordination: No information provided	2× online sessions, 2 h each session, 26‐page workbook	Inclusions: Active participant involvement, goal setting, therapeutic strategies, cognitive techniques, stretching
Opoku‐Anane et al. 2020	Gynaecology, *patient navigator, psychology	Medically led care Central profession: No information provided Coordination: Patient navigator role—single contact for coordination of services; monthly interdisciplinary case conferences	In‐person individual, telehealth individual, case conference. Optional 8‐week in‐person group program	Assessment: Gynaecologist, patient navigator, psychologist. Inclusions: Case conference, diagnosis and treatment planning, endometriosis excision surgery, psychologist, referral planning, medication management. mind–body skills, pain education, integrative medicine (acupuncture), sexual health, physical therapy
Shrikhande et al. 2023	Physiatry, pelvic floor physical therapy	Medically led care Central profession: Doctor (physiatrist) Coordination: No information provided	In‐person individual, physical therapy 1 h weekly, CBT 12× weekly sessions. Duration not reported	Assessment: History and physical examination (Physiatrist). Inclusions: Physiatry: Ultrasound guided trigger point injections, peripheral nerve blocks; CNS medications. Pelvic floor physical therapy: IMT, EMT, breath control training, education, lifestyle modifications. CBT: Pain science education, mindfulness, behavioural activation, cognitive restructuring, behaviour change
Twiddy et al. 2015	Pain medicine (physician), clinical psychology (pain management, sexual health, psychosexual therapy), physiotherapy, occupational therapy. Specialist interest/training in CPP	Pain management program Central profession: Doctor (pain medicine physician) Coordination: Joint planning sessions, interdisciplinary education sessions	In‐person 7‐week group, 1 day per week × 7 weeks, 40 h	Assessment: Interdisciplinary assessment. Inclusions: Mindfulness, ACT, CBT, education, reassurance, activity management, pain management, flare up management, postural retraining, low intensity exercise, mindful movement, reducing fear of movement, relationships, sexual function
Westbay et al. 2021	*Physical medicine and rehabilitation (physician), *internal medicine (physician), gynaecology, pelvic floor physical therapy, urology, *psychology, *nursing.	Medically led care Central profession: Doctor (physical medicine and rehabilitation physician) Coordination: Weekly MDT meetings	In‐person individual, visits (n = 2–5+). Duration and frequency not specified	Assessment: Interdisciplinary as required. Inclusions: Medication, physical therapy, surgical management, instillations, pelvic floor muscle trigger point injections. Psychology assessment and intervention not reported
Yong et al. 2018	Gynaecology, *pelvic floor physical therapy, *psychology, *nursing	Medically led care. Central profession: Doctor (gynaecologist) Coordination: Patient‐centred with gynaecologist	In‐person individual, in‐person group. Program duration and frequency not specified	Assessment: Gynaecologist, referral and treatment planning. Inclusions: Minimally invasive surgery, medication management. Group pain education: Sexual response cycle, responsive desire, sexual pain, female genital and pelvic floor anatomy, pelvic floor muscles in sexual function. Physical therapy: RT, education, graded exposure techniques, sensate focus, strategies to address pelvic girdle/hip pain and bladder and/or bowel concerns. Psychology: Emotional wellbeing, CBT, mindfulness, RT

Abbreviations: *, Qualifications not specified; ACT, acceptance and commitment therapy; CBT, cognitive behavioural therapy; CPP, chronic pelvic pain; EMT, external manual therapy; IMT, internal manual therapy; MDT, multidisciplinary team; MT, manual therapy; PMR, progressive muscle relaxation; RT, relaxation training.

3.3. What Specific Components Are Included in Interdisciplinary Programs?

Most programs included the common elements of assessment, education, pelvic physiotherapy, psychological management and biomedical treatments such as surgery and medications (see Table 2). Assessment processes and inclusions varied, with six programs (38%) detailing assessments by medical practitioners and six programs (38%) describing interdisciplinary assessment processes. Within the domain of education, content covered multifactorial contributors to pain and pain science, sleep hygiene, pelvic floor anatomy, anti‐inflammatory diet and the role of self‐management. Edwards et al. (2020) and Twiddy et al. (2015) described specific therapeutic programs that addressed intimacy, relationships and sexual function that covered a range of topics including sexual myths, managing feelings of embarrassment and shame, assertive communication, sexual response cycle, attentional focus and mindfulness, sexual anxiety, hypervigilance and fear, sensate focus and fertility (see Table 2).

Most programs included physiotherapy interventions (n = 14) and psychotherapeutic interventions (n = 13). Physiotherapy interventions included manual therapy, pelvic floor rehabilitation, bladder and bowel training, exercise and activity management, treatment of hip and pelvic girdle dysfunctions, reduction of fear avoidance behaviour, sexual therapy (e.g., sensate focus, desensitisation, pelvic floor relaxation) and adjunctive therapies (e.g., dilator therapy, percutaneous tibial nerve stimulation). Psychological treatments included cognitive behaviour therapy (CBT), mindfulness‐based approaches, acceptance and commitment therapy (ACT), counselling, relationship and sexual therapy, pain coping strategies, psychoeducation, mood and anxiety management. Sixty‐two percent of programs (n = 10) reported the inclusion of biomedical interventions such as endometriosis reduction surgery, peripheral nerve blocks, intramuscular and/or perineural injections, bladder instillations and pharmacotherapy.

Most programs included in‐person individual sessions (n = 10) or group sessions (n = 9), with fewer programs utilising telehealth or online formats (n = 3). Two programs explicitly described programs by female facilitators (Katz et al. 2021; Twiddy et al. 2015). Mixed‐gender pain programs provided separate pain management groups for each gender (Brünahl et al. 2018; Centemero et al. 2021; Edwards et al. 2020). The profession delivering the intervention varied, with some interventions consistently provided by one profession (e.g., ACT provided by psychologists, pelvic floor relaxation and dilator therapy provided by physiotherapists). Other interventions were provided by practitioners from a variety of professions (e.g., mindfulness, goal setting and CBT were provided by psychologists, physiotherapists, or occupational therapists). Sexual wellbeing information was provided by psychologists or physiotherapists, and pain management education was provided by multiple professions. Some of the reported programs did not describe which professions were responsible for managing and delivering program components (see Table 2).

3.4. How Is Interdisciplinary Care Organised and Coordinated?

Most programs (n = 10) did not provide any information regarding interdisciplinary communication and coordination. Just over half of the programs (n = 9) described a central profession that was noted to lead care. Central professions included medicine (disciplines of gynaecology: n = 3, pain medicine: n = 2, physiatry: n = 2, urogynecology: n = 1), and psychology (n = 1) (see Table 2). Only 38% (n = 6) of studies described explicit strategies for communication and coordination between professions and disciplines, including team meetings, case conferences, joint planning sessions for group education sessions, and nurses to assist with referrals and patient flow across multiple departments and divisions (e.g., ‘patient navigator’, Opoku‐Anane et al. 2020).

3.5. Are PWLE Involved in the Development and Refinement of Interdisciplinary Programs?

Only two studies reported explicit consultation with PWLE prior to program development (Boersen et al. 2021; Kreher et al. 2023). Boersen et al. (2021) conducted focus groups to identify the needs and preferences of individuals undergoing endometriosis‐related surgical interventions, using the results to develop a CBT‐focused intervention. Kreher et al. (2023) conducted a needs analysis survey with individuals experiencing persistent pelvic pain, using the findings to create content for an educational webinar.

Two additional programs described using patient questionnaires to inform program refinement. Edwards et al. (2020) detailed the refinement of their pelvic pain program over 5 years through interdisciplinary team discussions, review of patient‐reported concerns in the literature, and the use of patient‐reported measures to evaluate program outcomes. Twiddy et al. (2015) reported using the Canadian Occupational Performance Measure to inform and prioritise patient needs and goals in establishing their program.

4. Discussion

This scoping review provides an important overview of interdisciplinary care for pelvic pain, in terms of professions and disciplines included, treatments provided, ways of working and involvement of PWLE, laying a foundation for future research and development in this field. Most of the reviewed programs reported a median of three professions, though some were more extensive, incorporating up to seven. The most included professions were physiotherapy, psychology and gynaecology, followed by nursing, occupational therapy and social work. Dietitians were not often included, despite growing interest and evidence supporting dietary management for persistent pain (Field et al. 2021; Lowry et al. 2020), particularly regarding the role of anti‐inflammatory diets (Elma et al. 2022). Furthermore, irritable bowel syndrome (IBS) is prevalent among people with endometriosis and pelvic pain (Chiaffarino et al. 2021; Choung et al. 2010; Nabi et al. 2022; Saidi et al. 2020), with growing evidence to support low FODMAP diets in reducing bloating and pain associated with IBS (Black et al. 2022; Moore et al. 2017; Van Lanen et al. 2021). Similarly, alternative and complementary therapies were seldom included, even though they are often used by individuals with pelvic pain (Armour et al. 2019; Malik et al. 2022). Further research is needed to determine the optimum mix of professions for effective pelvic pain care.

Interdisciplinary care involves different professions working collaboratively to enhance and coordinate care (RANZCOG 2021). Despite widespread recommendations for interdisciplinary care in the management of pelvic pain (Mardon et al. 2022; Troncon et al. 2023), most studies in this review described multidisciplinary care, where professions work alongside each other, with limited information provided regarding interdisciplinary collaboration, communication or coordination of care. Just over one third of studies, however, did provide evidence for interdisciplinary coordination, including strategies such as interdisciplinary assessments (Katz et al. 2021; Opoku‐Anane et al. 2020; Twiddy et al. 2015; Westbay et al. 2021), interdisciplinary education (Edwards et al. 1992; Twiddy et al. 2015), interdisciplinary meetings (Centemero et al. 2021; Opoku‐Anane et al. 2020; Westbay et al. 2021), joint planning sessions (Twiddy et al. 2015) and the role of a care coordinator (Agarwal et al. 2019; Centemero et al. 2021; Opoku‐Anane et al. 2020) to assist with organising care. These strategies provide evidence of a shift towards interdisciplinary ways of working in the management of pelvic pain, with further research recommended to explore the most effective models for interdisciplinary coordination. Future studies should clearly describe the strategies used to organise and coordinate interdisciplinary care.

Fifty percent of the included studies described medically led programs (by gynaecologists) that focused on assessment, diagnosis, care planning, surgery, medication, physiotherapy and psychological management, with the occasional inclusion of alternative and complementary therapies (Agarwal et al. 2019; Opoku‐Anane et al. 2020). The remaining 50% of included studies described pain management programs that tended towards team led care, and emphasised assessment, education and treatment from different allied health professions (e.g., physiotherapy, psychology, occupational therapy). Pain management programs provided more intensive, longer‐duration conservative management, including both individual and group therapy, often on a weekly basis for up to 3 months.

This review found common components of pelvic pain care were assessment, education, pelvic physiotherapy, psychological management and various biomedical treatments. Whilst assessment was included in most programs, there was a lack of consistency in assessment processes, and only 38% of studies described interdisciplinary assessment methods. Over 90% of programs included education, primarily provided by physiotherapists and psychologists (Allaire et al. 2018; Kreher et al. 2023; Yong et al. 2018). This aligns with the broader literature on pelvic pain management (Alappattu et al. 2019; Brooks et al. 2021) and the recommended inclusion of education in treatment guidelines (Mardon et al. 2024). Education content varied between studies and included a wide range of topics related to how pain works (e.g., pain science, pain mechanisms, biopsychosocial contributors to pain) and how to manage pain (e.g., pain management skills such as managing stress, avoidance reduction, relaxation training, activity management, managing intimacy and relationships, medications and flare up management).

Despite the high prevalence of sexual concerns and dysfunction associated with persistent pelvic pain, and their impact on health‐related quality of life and relationship wellbeing (Van Niekerk et al. 2024), only one‐third of the reviewed programs specifically addressed intimacy and sexual function (Boersen et al. 2021; Edwards et al. 2020; Katz et al. 2021; Twiddy et al. 2015; Yong et al. 2018). These programs typically involved content provided by psychologists and pelvic physiotherapists, including pain education, mindfulness, sensate focus, avoidance reduction, desensitisation, communication strategies and flare‐up management. Women with pelvic pain report challenges discussing sexual difficulties due to embarrassment, shame and stigma (Davenport et al. 2024; Edwards et al. 2020). Similarly, health professionals encounter barriers in addressing sexual health issues, such as embarrassment, time constraints and a lack of competence and skills (Thorpe et al. 2022). It may be that sexual wellbeing is best managed via single profession programs (Bittelbrunn et al. 2022) rather than through interdisciplinary care.

The profession providing pain treatments varied across reviewed programs. Some interventions were consistently provided by specific professions, such as ACT by psychologists, and pelvic floor relaxation, dilator therapy and manual therapy by physiotherapists. Other interventions, like mindfulness, goal setting and CBT, were delivered by various professions, including psychologists, physiotherapists and occupational therapists. Sensate focus was delivered by both physiotherapists and psychologists, while activity management was provided by both occupational therapists and physiotherapists. Sexual wellbeing information was usually provided by both psychologists and physiotherapists, while pain management education was offered by multiple professions.

The overlap of common treatments provided by different professions, along with some evidence for defined roles and scope of practice, sets the stage for interprofessional pelvic pain care. However, some studies did not clearly specify which professions were responsible for treatments or define the provider's scope of competency, especially for treatments typically provided by another profession. Further research is needed to determine whether the limited delineation between provider roles is due to program resources (e.g., funding models, staffing costs) or practitioner training and competency. The costs associated with maintaining an interdisciplinary pelvic pain service may indeed lead to the adoption of multidisciplinary models (Armour et al. 2022).

Despite recommendations to include PWLE (Australian Government, Department on Health 2018) in the development of pelvic pain programs, we found limited evidence for this, with only two studies reporting such engagement (Boersen et al. 2021; Kreher et al. 2023). Increased involvement of PWLE is a key focus of pain care internationally, with growing recognition of the value and equity that lived experience expertise can bring to healthcare design (Armour et al. 2022; Young et al. 2015). Given that women with pelvic pain frequently feel ‘unheard’ or ‘minimised’ by healthcare professionals (Hawkey et al. 2022), incorporating PWLE into program development is recommended. Similarly, a notable omission from the reviewed programs was the explicit reference to trauma informed care principles (Knight 2019; Meltzer‐Brody et al. 2007; Panisch and Tam 2020; Ross et al. 2023). Women with pelvic pain frequently report health‐related trauma, regardless of childhood sexual abuse (Ross et al. 2023). There is a critical need for healthcare to be delivered in a manner that does not exacerbate or contribute to health‐related trauma, with a recommendation that studies report the inclusion of trauma informed practices within their program protocols (Huo et al. 2023).

Several limitations of the current review are noted. Despite developing and refining a detailed search strategy with the help of a research librarian and the research team, it may not have captured all existing alternative terms. Additionally, the review was limited to studies published in English, which increases the potential for selection bias. Furthermore, this narrative synthesis did not include a discussion of outcomes associated with interdisciplinary programs, as it was designed to focus on program components rather than effectiveness or clinical change. By including descriptive studies of pelvic pain programs, rather than limiting to outcome studies, this review aimed to provide a broader understanding of current interdisciplinary care practices. Future research could investigate the outcomes associated with interdisciplinary pelvic pain care.

5. Conclusions

This scoping review highlights the complexity and variability of interdisciplinary care for persistent pelvic pain. Common treatment components included assessment, education, pelvic physiotherapy, psychological management and specialist medical treatments, with physiotherapy, psychology and gynaecology being the most frequently included professions. PWLE were rarely involved in program development, and limited information was provided regarding gender diversity and trauma‐informed care principles. This scoping review sets the scene for interprofessional practice by describing a range of coordination strategies that can be used to facilitate true interdisciplinary care as recommended in clinical guidelines. However, most programs are still operating within multidisciplinary paradigms, with professions working alongside each other, rather than working collaboratively with each other and with patients to provide coordinated care. The current scoping review provides valuable insights to inform future research and practice in the field of interdisciplinary pelvic pain care, highlighting the need for greater inclusion of PWLE in program design and greater standardisation of interdisciplinary care so that outcomes can be evaluated.

Author Contributions

C.A. and L.V.N. conceived the study, screened studies for inclusion, reviewed full text articles and extracted data. L.V.N. registered the protocol with Open Science Framework. C.A. and L.V.N. drafted the first manuscript, which was reviewed by all authors. All authors discussed the results and provided feedback on the manuscript, which was incorporated into the final version. All authors approved the final version of the review. L.V.N., M.‐L.B. and K.J. provided supervision.

Conflicts of Interest

The authors declare no conflicts of interest.

Supporting information

Table S1. Key concepts and free text terms for search strategy.

Table S2. Medline search strategy.