When Pain is more than "Endometriosis"

Why Every Woman Deserves a Neuropelveological Diagnosis

For countless women, pelvic pain becomes a long, exhausting journey through different specialties, repeated examinations, many labels and, all too often, the feeling of not being understood. Many receive diagnoses such as endometriosis, interstitial cystitis, vulvodynia, coccygodynia, pelvic floor tension or simply “psychosomatic pain.” These labels describe symptoms but rarely explain why the pain exists, how it behaves or where it truly originates. They do not reveal the mechanism behind the suffering, even though most of these symptoms follow a very precise neurofunctional logic.

This missing logic - the neurofunctional behavior of pelvic nerves and the interaction between the somatic and autonomic nervous systems - is not part of traditional gynecological training. Gynecologists are extraordinarily skilled in treating endometriosis, oncological diseases, fertility issues, obstetrics and organ-based conditions. But they are not taught how pelvic nerves transmit pain, how nerve structures react to compression or inflammation, or how nerve dysfunction can mimic problems in completely different organs. It is therefore not surprising that even the most experienced endometriosis surgeons or oncologists would not pass a theoretical ISON Level 1 exam: the knowledge simply does not exist in conventional gynecological curricula.

This explains why many women receive contradictory or incomplete diagnoses. A gynecologist can only look for what he or she has been trained to identify: visible lesions, cysts, nodules or structural abnormalities. If nothing obvious appears, the pain is often categorized as functional, muscular, psychosomatic or unexplained. Women leave consultations hearing that everything “appears normal,” that “the pain does not match the findings,” or that “stress may be contributing.” But this is not because the physician lacks empathy or competence. It is because the problem lies outside the framework of their training. They have not been taught to interpret the language of pelvic nerves.

Neuropelveology offers a completely different way of thinking. It does not begin with the organs but with the nervous system. It seeks to understand how each pelvic nerve behaves, how it can be irritated or compressed, and how such irritation produces symptoms that often appear to belong to entirely different medical specialties. When the sciatic nerve is irritated inside the pelvis, the symptoms manifest in the leg -pain, movement difficulties or sensory changes - which are easily mistaken for orthopedic problems. When pelvic autonomic nerves are affected, bladder dysfunction appears and is interpreted as urological. When nerves serving the bowel are disturbed, the symptoms resemble gastroenterological conditions. And when the genital nerves are involved, the symptoms are classified as gynecological - or urological in men. What seems like a confusing mixture of unrelated problems is, in reality, a coherent neurofunctional pattern.

For most gynecologists this combination of symptoms from different specialties is frustrating and deeply confusing. For a neuropelveologist, however, it is the most important and meaningful part of the diagnostic process. Neuropelveology is detective work. Each symptom, each detail, each seemingly unrelated functional disturbance becomes a clue that helps identify which nerve is involved, where in the pelvis the problem originates and whether the nerve is irritated, compressed or injured. In this discipline, the diagnosis is not the name of a disease such as endometriosis; the diagnosis is an understanding of the nerve, its pathway and its dysfunction.

Such a diagnosis requires not only knowledge but also time, an element that modern medicine often lacks. Even after more than twenty years of experience and as the founder of this discipline, I still need between one and two hours per patient to take a detailed neuropelveological history. This time is not a luxury; it is the essential foundation of an accurate diagnosis. Without it, the complexity of pelvic nervous system disorders cannot be understood. Neuropelveology cannot be performed in a ten-minute consultation. It demands a deep, meticulous synthesis of information that spans neurology, gynecology, urology, gastroenterology and pain medicine.

Patients have no simple way of knowing who truly possesses this expertise. Many clinicians may use the term “neuropelveology,” but only one standard guarantees authenticity: ISON certification. The International School of Neuropelveology (ISON) is the highest authority in this field, and its certification ensures that a clinician has the theoretical and practical knowledge to diagnose pelvic nerve pathologies correctly. I created both the discipline and the certification pathway, and for more than twenty years I have carefully safeguarded its integrity to ensure that only those who place the well-being of the patient at the center of their practice may call themselves neuropelveologists. Neuropelveology is not a trend or a title to gain prestige. It is a legacy built on integrity, precision and responsibility toward every patient. Women deserve nothing less.

Pelvic pain is rarely random. It follows the language of nerves - clear, logical and precise - if someone knows how to listen. A neuropelveological diagnosis does not replace gynecology; it completes it. It gives meaning to symptoms that were previously misunderstood, dismissed or fragmented across different specialties. It brings together what was scattered. And for many women, this moment of understanding is the beginning of real healing, because someone finally sees not just one part of their suffering, but the whole picture.