Chronic pelvic pain, East Asian medicine & the LGBTQ+ community

The lower abdomen is sometimes referred to, in kinesthetic medicines of various kinds, as “the basement of the body”. It’s where issues that we can’t deal with at the moment, whether emotional or physical, get put so that can work on them later. Hopefully.

This dynamic can be illustrated in a few ways: sexual assault survivors have a heightened risk for pelvic inflammatory disorder (3), inflammatory bowel disease (a complex issue for another article), and menstrual pain (2). Increased pelvic pain, urinary tract infections (UTIs) and back pain have been documented in women who are survivors of domestic violence (1).

More broadly, the Adverse Childhood Experiences study has found that adults with childhood traumas are many times more likely than baseline populations to experience a wide variety medical problems, including all-cause mortality (4). The pelvic bowl is not the only place where traumatic events show up as physical symptoms later on, but it is one of the main things that manual medicine providers see clinically.

This literature can feel pretty scary for survivors of any kind of traumatic event, so I want to be super clear about something: risk factors are not guarantees of future illness.

It is not the case that 100% of survivors go on to have serious medical problems beyond the effects of aging. It is also the case that risk factors, and their early symptoms, are often quite treatable, which I’ll discuss further down the page.

I’ve written before (link to previous article) about the higher instances of untreated illness among queer and trans populations, and here is a place where we should return to those findings. Not all queer and trans people have experienced severe trauma over the course of our lives, but many have. This has obvious implications for the baseline risk factors that we have in the world, but it can also combine with societal risk factors to create a pretty toxic sludge of comorbidity (the medical term for multiple medical risk factors or illnesses occurring at once).

For example, imagine a cisgender gay man who is also a sexual assault survivor, and who is experiencing unexplained testicular pain.

If his medical provider is uncomfortable with queer patients, that person may not inquire deeply enough about said pain, or may be unwilling to properly examine the patient. In such case, a possible tumor might not be discovered until it has progressed into something much more difficult to treat. Because we are dealing with complex human beings, the many possible permutations of these phenomena are pretty much endless.

In East Asian medicine, we also have some extra tools available to us in terms of early treatment.

Basically, from this perspective, most problems begin as stagnation of Qi (the body’s life force), and if Qi stagnation goes on for too long then blood begins to stagnate. In the case of pelvic pain, let’s say that a 25-year-old bisexual trans man presents with wandering and intermittent pain in his lower abdomen. The pain began shortly after he experienced a car accident, and has been getting worse every since then. In this case, the emotional shock to the heart from the accident has lead to Qi stagnation in the liver channel, which is closely linked with the heart and passes through the pelvic bowl.

If left untreated, such a patient could develop more overt disease symptoms, such as uterine fibroids or polyps. When a symptom manifests with a physical tissue change, and is accompanied by a fixed pain rather than a wandering one, then something has progressed into the realm of blood stagnation. Both Qi and blood stagnation are treatable, but Qi stagnation resolves more quickly and is far less frightening and painful for the patient. If this can be treated at the stage of pain that no one can pin down, this is ideal.

Needless to say, having a safe provider to see about this pain is one of the biggest factors in whether or not this patient would be able to access care for it.

Assuming that he did, treatment in the early stages for such a case would involve acupuncture techniques to reestablish proper flow of Qi in the liver channel, as well as other channel in the lower abdomen, and also to restore the Qi of the heart. This would generally have the knock-on effect of also resolving any anxiety, depression or sleep issues that may be lingering from the car accident. If treatment were to occur in the blood stagnation stage, then the above steps would be taken, along with needling techniques and herbs to break up stagnant blood and help the body to reestablish the appropriate flow and rhythm of blood in the lower abdomen.

In either case, this patient being aware of his own bodily and emotional experience is the most important factor in accessing any kind of care.

The best way that we can care for ourselves is to understand how our lives effect us. East Asian medicine can be an important tool for anyone who wants to recover from a traumatic event, treat an early-stage illness, or finally address a problem that has been bothering them for a long time.

Works Cited

(1) Campbell J, Jones AS, Dienemann J, Kub J, Schollenberger J, O’Campo P, Gielen AC, Wynne C. Intimate Partner Violence and Physical Health Consequences. Arch Intern Med. 2002;162(10):1157–1163. doi:10.1001/archinte.162.10.1157

(2) Jacqueline M. Golding. Sexual-Assault History and Long-Term Physical Health Problems. Current Directions in Psychological Science Vol 8, Issue 6, pp. 191 – 194. First published date: June-24-2016

(3) Latthe Pallavi, Mignini Luciano, Gray Richard, Hills Robert, Khan Khalid. Factors predisposing women to chronic pelvic pain: systematic review BMJ 2006; 332 :749

(4) Vincent J Felitti, Robert F Anda, Dale Nordenberg, David F Williamson, Alison M Spitz, Valerie Edwards, Mary P Koss, James S Marks, Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults, American Journal of Preventive Medicine, Volume 14, Issue 4, 1998, Pages 245-258, ISSN 0749-3797, http://dx.doi.org/10.1016/S0749-3797(98)00017-8.

Written by Rowan Everard


I discovered Chinese medicine shortly after moving to Portland to complete my undergraduate studies. I began my journey as a patient, but after several years of being an increasingly curious patient I found myself drawn into the formal study of this medicine. In Chinese medicine, I found tools that helped me to transform myself, and which I have seen lead to dramatic positive shifts in patients.