May 2025
Dr. Sonia Bahlani, an OB/GYN and urology-trained specialist, is a leading expert in pelvic pain. With a holistic, patient-centered approach, she develops personalized treatments to improve women's quality of life. A researcher, speaker, and author, she’s been featured in top media outlets and recently released Dr. Sonia’s Guide to Navigating Pelvic Pain.
With your extensive experience, how do you differentiate between various forms of pelvic pain syndromes in a clinical setting?
Pelvic pain is not a one-size-fits-all diagnosis. As a pelvic pain specialist, my first step is always to listen—really listen—to the patient’s story. The nuances in symptom timing, character, and triggers often guide me toward the correct diagnosis. For instance, pain that’s cyclical and tied to menstruation might suggest endometriosis, whereas burning pain with no visible lesions could point to vulvodynia or a neuropathic cause. Pain with urination or bladder filling might raise suspicion for interstitial cystitis.
I also take into account the overlap between systems—the bladder, bowel, musculoskeletal system, and even the nervous system can all be involved. So I perform a comprehensive exam that includes pelvic floor muscle assessment, neurological evaluation, and sometimes use targeted imaging or diagnostic blocks.
But perhaps most importantly, I approach each patient with the understanding that pelvic pain is complex, and often multifactorial. It’s not just about naming a condition—it’s about identifying the unique contributors in that individual’s case so I can create a tailored, effective treatment plan.
What innovative diagnostic or therapeutic techniques have you integrated into your practice to improve outcomes for patients with vaginal and pelvic health issues?
Innovation in pelvic pain care starts with rethinking the traditional approach. I’ve integrated a multimodal diagnostic framework that includes high-resolution pelvic floor ultrasound, advanced neurodynamic testing, and when appropriate, selective nerve blocks—not just to treat, but to help clarify the pain generators. This gives us a real-time, dynamic view of how muscles and nerves are functioning.
Therapeutically, I’ve adopted a collaborative model that goes beyond prescriptions. I use a combination of pelvic floor physical therapy, targeted neuromodulation (like pudendal nerve stimulation), and trauma-informed care strategies. I also incorporate the latest in vaginal microbiome science, recognizing how crucial it is to vaginal and pelvic health.
And honestly, innovation also means challenging outdated narratives. I work to give my patients language, validation, and agency in their healing. That alone can shift outcomes more than any one tool.
Your work has been instrumental in addressing the stigma around vaginal health—what practical steps do you take to create a more open dialogue with your patients and peers?
The stigma around vaginal and pelvic health thrives in silence—and my mission is to break that silence with both science and compassion. In the clinic, I start by naming things clearly and without euphemism. If we can say ‘migraine’ or ‘heart disease,’ we should be able to say ‘‘vulvodynia’ or ‘dyspareunia’ without shame. That kind of transparency gives patients permission to speak freely.
I also take time to validate their experiences—many of my patients have been dismissed or misdiagnosed for years. That acknowledgment alone can be a turning point. With peers, I push for pelvic health to be treated as a core part of medicine, not a fringe specialty. I advocate for interdisciplinary collaboration—bringing gynecology, urology, physical therapy, mental health, and even gastroenterology into the same conversation. And I use platforms like Instagram, podcasts, and panels to bring pelvic health out of the shadows.
We’re not just treating pain—we’re changing culture, shifting paradigms, and disrupting healthcare as we know it.
What role does the nervous system play in vaginal pain, and why is it essential for healthcare providers to consider neurogenic components in their treatment approach?
The nervous system is central—literally and figuratively—to how we experience vaginal pain. It’s not just about tissue damage or infection; it’s about how the body processes pain. When we overlook the neurogenic components, we risk treating symptoms in isolation and missing the deeper drivers of chronicity.
In conditions like vulvodynia, pudendal neuralgia, or post-surgical pain, it’s often the nerves that are either irritated, hypersensitized, or caught in a feedback loop where the pain persists even after the initial insult is gone. This is where neuroplasticity—the nervous system's ability to rewire—comes into play. And unless we address that through desensitization techniques, nerve blocks, neuromodulators, or even pelvic floor physical therapy with a neuro-informed approach, we may not see meaningful improvement.
It’s essential for healthcare providers to recognize that vaginal pain isn’t always ‘in the tissue’—sometimes it’s in the wiring. And if we don’t include the nervous system in our assessment, we’re not giving our patients the full scope of care they deserve.
Despite the growing body of evidence supporting non-surgical treatments for vaginal and pelvic pain, many patients are still fast-tracked to surgery or dismissed entirely. How do you advocate for evidence-based approaches in your practice—and what do you see as the most underutilized tools in this space?
There is a wealth of non-surgical, evidence-based approaches that can and should be part of first-line care for vaginal and pelvic pain. Too often, patients are fast-tracked to surgery or told to 'just live with it'—but the data tells us there’s so much more we can do.
Pelvic floor physical therapy is foundational. It’s not just Kegels—it's about downtraining overactive muscles, restoring mobility, and teaching the nervous system to recalibrate its response to pain.
Neuromodulation—whether through medications like SNRIs, nerve blocks, or even newer techniques like transcutaneous electrical nerve stimulation (TENS)—can help target the neurogenic components of pain.
Cognitive behavioral therapy (CBT) and pain neuroscience education are backed by strong evidence for chronic pain syndromes. When patients understand the ‘why’ behind their pain, we see real shifts in outcomes. And we’re learning more about the role of the vaginal microbiome—how imbalances can contribute to inflammation and discomfort and how supporting that ecosystem with targeted therapies can aid in healing.
This is a systems-based approach. When we integrate these tools thoughtfully, we not only reduce pain—we rebuild trust in the body.
When it comes to treating vaginal and pelvic pain, localized therapies can make a powerful impact—especially when systemic treatments fall short. Here's how I integrate topicals, suppositories, and injections into care plans:
Topical Medications: Compounded creams containing agents like lidocaine, amitriptyline, or gabapentin can help desensitize irritated nerves at the vulvar or vestibular level. They're particularly useful in vulvodynia or provoked vestibulodynia, and offer a targeted, side-effect-sparing option.
- Valium Suppositories: These vaginal or rectal diazepam suppositories are used to reduce pelvic floor muscle spasm and hypertonicity. For patients with high-tone pelvic floor dysfunction, they can be a game-changer—especially when paired with pelvic floor physical therapy.
- Botox Injections: OnabotulinumtoxinA injections into the pelvic floor muscles can be helpful for refractory myofascial pain or high-tone dysfunction. By reducing sustained muscle contraction, Botox not only eases pain but also allows patients to better engage in rehab and retrain the nervous system.
- Trigger Point Injections: With or without anesthetic, trigger point injections into hyperirritable pelvic floor muscles help release myofascial knots and reduce referred pain. They're especially useful in patients with centralized pain syndromes or after trauma, surgery, or prolonged tension patterns.
These interventions aren't one-size-fits-all—but when selected thoughtfully, they can offer targeted relief, help break chronic pain cycles, and empower patients to reclaim function and comfort.