Endometriosis can cause pelvic pain, abdominal pain, painful periods, pain with sex, bowel or bladder pain, and persistent symptoms that may continue even after gynecology care or surgery.
Learn how Dr. Ahmed discusses endometriosis, its connection to chronic pelvic pain, and personalized treatment options to help patients find relief.
Our team organizes conditions and treatments into related zones of expertise to make it easier to explore the care paths most relevant to your symptoms and goals.
Use the zone tags above to browse dedicated pages for each focus area, including services, providers, and what to expect during treatment.
Endometriosis is a condition where tissue similar to the lining of the uterus grows outside of it. Over time, this can lead to inflammation, irritation, and pain that can become chronic.
A lot of people think of endometriosis as just pain with periods, but it can show up in many different ways. Patients may experience pelvic pain, pain with intercourse, bowel or bladder symptoms, or even pain in the low back or hips.
One of the most important things to understand is that this pain is often multifactorial.
Even after surgery, some patients continue to have pain because the pelvic floor muscles can become tight and reactive, and nearby nerves can stay sensitized after months or years of discomfort. So while treating the endometriosis itself is important, we also need to look at how the muscles and nervous system are contributing to ongoing pain.
At Manhattan Pain Medicine, my approach is to really understand each person’s full experience. We evaluate the pelvic floor, the nerves, and patterns of pain, and then build a treatment plan that may include pelvic floor therapy, targeted treatments, and coordination with your gynecologist.
The goal is to create a plan that feels connected and complete, so you’re not just managing symptoms, but actually improving how your body feels and functions over time. If you’ve been dealing with ongoing pelvic pain and haven’t found clear answers, it may be helpful to take a more comprehensive look at what’s contributing to your symptoms.
Endometriosis is a condition in which tissue similar to the lining of the uterus grows outside the uterus. It can cause pelvic pain, painful periods, lower abdominal pain, back pain, pain with sex, pain with bowel movements, pain with urination, bloating, and fertility concerns.
For some patients, pain occurs mainly around the menstrual cycle. For others, endometriosis-related pain becomes more persistent and may occur outside the menstrual period. Pain can also continue after hormonal therapy, pelvic floor therapy, surgery, or imaging that does not fully explain the severity of symptoms.
At Manhattan Pain Medicine (MPM), evaluation focuses on the pain pathways that can overlap with endometriosis. MPM does not replace gynecology or endometriosis surgery. Instead, our role is to help identify and treat overlapping pain generators, including pelvic floor dysfunction, pudendal neuralgia, abdominal wall nerve irritation, sacroiliac joint dysfunction, hip-related pain, sympathetic pain, central sensitization, and pain-related distress.
At MPM, endometriosis-related pain evaluation begins by mapping the pain pattern, cycle relationship, location, triggers, prior gynecology care, prior surgery, medication history, pelvic floor findings, and related bowel, bladder, hip, back, abdominal, or nerve symptoms.
For patients looking for endometriosis pain treatment in Manhattan, MPM evaluates whether symptoms may involve endometriosis lesions, pelvic floor muscle guarding, pudendal neuralgia, abdominal wall nerve entrapment, sacroiliac joint dysfunction, hip impingement, labral tears, hernia-related pain, fibroids, constipation, central pain syndromes, EDS, hypermobility, or autonomic symptoms.
Care may include medication management, pain psychology, biofeedback, acupuncture, trigger point injections, pelvic floor trigger point injections, pudendal nerve block, ganglion impar block, superior hypogastric plexus block, sacroiliac joint injection, sympathetic blocks, ultrasound-guided injections, peripheral nerve stimulation, or other selected options when clinically appropriate. MPM also coordinates with gynecology, endometriosis surgeons, pelvic floor physical therapy, GI, urology, orthopedics, and other specialists when needed.
Endometriosis pain can persist for several reasons. Some patients may have residual disease, recurrence, scar tissue, or ongoing inflammation. Others may develop pelvic floor guarding, nerve sensitization, abdominal wall pain, hip or sacroiliac contributors, bladder or bowel overlap, or central pain sensitization.
Persistent pain does not mean the original diagnosis was wrong. It may mean the pain has become layered over time. A patient may have endometriosis and pudendal neuralgia, endometriosis and pelvic floor dysfunction, endometriosis and hip impingement, or endometriosis and central pain sensitivity.
MPM’s diagnosis-first approach is designed to identify these overlapping pain generators and determine which treatments belong in the care plan. The goal is not to treat endometriosis lesions directly, but to help address the pain pathways that may continue to affect daily function.
Endometriosis is most closely connected to MPM’s Pelvic Pain Zone of Expertise, with important overlap in Complex Chronic Pain, Autonomic dysfunction, and Psychology of Pain.
Pelvic Pain is relevant when symptoms involve the pelvis, pelvic floor, reproductive organs, bladder, bowel, pudendal nerve, sacroiliac joint, hip, abdominal wall, or tailbone. Complex Chronic Pain is relevant when symptoms persist, spread, or become layered over time. Autonomic dysfunction may be relevant when symptoms overlap with bowel changes, bladder symptoms, dizziness, nausea, fatigue, or postural symptoms. Psychology of Pain is relevant when chronic pain affects fear, sleep, stress, medical trauma, or the ability to safely reengage with care.
MPM evaluates these relationships carefully so treatment can be matched to the patient’s pain pattern rather than applied as a one-size-fits-all approach.
These guys are the best. I've been going here for over 6 years and their familiarity with my Schwannomatosis (most ppl have never even heard of it - its rather rare) and their ability to diagnose my CRPS quickly and accurately and then treat it like I was merely getting a flu shot is just incredible...
Highly recommended for those who need Pain Management. Everyone at Manhattan Pain Medicine is extremely nice and helpful. I have had very good interactions with both Dr. Siefferman and Dr. Louis. All of the staff is very responsive. 5 stars.
The providers at Manhattan Pain Medicine are exceptional. I wish I had found them 30 years ago!
I genuinely can’t say enough good things about the team at Manhattan Pain Medicine. I have MCAS, EDS, and an inflammatory autoimmune disease, and I’ve basically been searching for answers since I was a kid. I had years of unexplained inflammation markers, chronic pain, and allergic reactions despite...
I have a complex medical history and have seen a lot of doctors over the years. Dr. Mikaberidze and Dr. Siefferman each took the time to really listen and understand everything I had been dealing with. I also appreciated how they work together and communicated about my care. I left with a plan that...
Sharing my gratitude for the pleasant experience last week during my visit, the medical team provided great care and also treated my session as a learning experience, I left my session with a wealth of knowledge. A big thank you to the kind, and professional staff who welcomed me to the office as a...
I cannot say enough good things about Manhattan Pain Medicine. From the moment I walked in, I felt truly cared for and taken seriously. Dr. Nino Mikaberidze, Director of Rheumatology, is exceptional — knowledgeable, compassionate, and incredibly thorough. She takes the time to listen, explains every...
Dr Siefferman is the most thorough, patient doctor I have even been to. Currently I travel from miami to nyc to see him because his bed side manner and desire to help is incomparable.
ZocDoc
This practice is wonderful. I have been a patient of Dr. Siefferman’s since 2019 and he’s extremely helpful and kind. He has brought in a Rheumatologist who is also great. They handle very complex pain issues and always try to find new ways to help me.
Dr. Siefferman is an incredible doctor! He is extremely diligent and knowledgeable. It feels like you are his only patient. He invests a lot of time and effort into your injuries and concerns. I did not find these wonderful qualities with other pain specialists before, who were always rushed and som...
ZocDoc
Dr. Siefferman is a doctor who combines the old world bedside manner of doctors from my childhood (60 years ago) with a sta te of the art embrace of modern technology. It is always a pleasure to have an appointment with him...always has options and solutions to my medical issues. He is truly the doc...
ZocDoc
Dr. Siefferman is a genius. He is very informed and listens attentively.
ZocDoc
Dr. Siefferman and his entire team continue to be efficient, dedicated, and driven by precision and a genuine desire to give fantastic care. Will always recommend.
ZocDoc
Doctor Siefferman is fantastic. Have been seeing him for 5 years. Couldn’t recommend more.
ZocDoc
Dr. Siefferman is the ONLY doctor who has ever been able to diagnose my pain and treat it. He is hands down the best
ZocDoc
Endometriosis pain may feel like severe menstrual cramping, deep pelvic pain, lower abdominal pain, low back pain, pain with sex, pain with bowel movements, pain with urination, rectal pressure, bladder discomfort, bloating, or nerve-like pelvic pain. Some patients have pain mainly during their period, while others develop pain outside the menstrual cycle or daily pelvic pain.
Yes. Endometriosis can contribute to chronic pelvic pain, especially when symptoms persist or recur over time. Pain may come from endometriosis itself, but it may also overlap with pelvic floor dysfunction, pudendal neuralgia, abdominal wall pain, sacroiliac joint dysfunction, hip pain, bladder or bowel symptoms, scar tissue, central sensitization, or complex chronic pain mechanisms.
Yes. Some patients continue to have pain after endometriosis surgery. Persistent pain may involve residual disease, recurrence, scar tissue, pelvic floor muscle guarding, nerve sensitization, abdominal wall pain, hip or SI joint contributors, or central sensitization. MPM evaluates these overlapping pain generators while coordinating with gynecology or endometriosis specialists when additional surgical or medical care is needed.
Yes. Endometriosis can be associated with pain during bowel movements, pain with urination, pelvic pressure, bladder discomfort, constipation, diarrhea, bloating, or pain that worsens during menstrual flares. Bowel and bladder symptoms should be evaluated carefully because they may also come from GI, urologic, pelvic floor, nerve-related, or abdominal wall conditions.
Yes. Chronic pelvic pain can cause the pelvic floor muscles to guard, tighten, or become poorly coordinated. Pelvic floor dysfunction may contribute to sitting pain, pain with sex, bowel or bladder symptoms, rectal discomfort, tailbone pain, or pelvic pressure. Pelvic floor dysfunction can persist even when endometriosis has been treated, which is why coordinated evaluation is important.
Endometriosis-related pain can overlap with nerve sensitization and nerve-related pelvic pain. Some patients may have pudendal neuralgia, abdominal wall nerve irritation, pelvic nerve sensitization, scar-related nerve pain, or sympathetically mediated pain patterns. Nerve-related pain may feel burning, electric, sharp, shooting, tingling, numb, or worse with sitting.
Treatment depends on the diagnosis and pain generator. Care may include gynecology management, medication management, pelvic floor therapy coordination, pain psychology, biofeedback, acupuncture, trigger point injections, pelvic floor trigger point injections, pudendal nerve block, ganglion impar block, superior hypogastric plexus block, lumbar sympathetic blocks, sympathetic blocks, sacroiliac joint injection, peripheral nerve stimulation, ketamine therapy, lidocaine and ketamine infusions, or other selected interventions when clinically appropriate.
A pain specialist may help when endometriosis-related pain persists despite gynecology care, surgery, hormonal therapy, pelvic floor therapy, or imaging that does not explain the full symptom pattern. MPM evaluates overlapping pain contributors, including pelvic floor dysfunction, nerve pain, abdominal wall pain, hip and SI joint pain, bowel or bladder overlap, central sensitization, and pain-related distress, while coordinating with gynecology and other specialists.
Before care begins, our team helps patients understand the practical side of treatment, including insurance verification, out-of-network benefits, cost-share estimates, self-pay options, and billing questions. We believe patients should have as much clarity as possible before moving forward.
Endometriosis is a pelvic pain condition that can affect far more than the menstrual cycle. Many patients experience painful periods, lower abdominal pain, back pain, pain with sex, pain with bowel movements, pain with urination, bloating, nausea, bowel changes, bladder symptoms, fatigue, or pain that continues outside the menstrual period.
For some patients, endometriosis is diagnosed after years of symptoms. Others are diagnosed after imaging, clinical evaluation, laparoscopy, or surgery. Some patients improve with hormonal treatment, excision, ablation, pelvic floor therapy, or other gynecology care. Others continue to have pain because the pain pattern has become more complex.
Endometriosis pain may begin with inflammation, lesions, adhesions, hormonal cycling, or irritation of nearby pelvic structures. Over time, pain can become layered. Pelvic floor muscles may tighten in response to pain. Nerves may become more sensitive. Scar tissue may irritate local tissues. Hip, sacroiliac, abdominal wall, bowel, bladder, and pelvic floor contributors may become part of the symptom pattern.
This is why MPM does not treat endometriosis-related pain as one single source. The goal is to identify which pain pathways are active and which specialists should be part of the plan.
Some patients continue to have pelvic pain after endometriosis surgery. This can happen for many reasons. There may be residual disease, recurrence, scar tissue, pelvic floor dysfunction, abdominal wall nerve irritation, pudendal neuralgia, hip-related pain, sacroiliac joint dysfunction, bowel or bladder overlap, or central pain sensitization.
Persistent pain after surgery does not mean the pain is not real. It also does not mean the surgery was necessarily unsuccessful. It may mean the original diagnosis was only one part of a broader pain picture.
MPM evaluates persistent symptoms after endometriosis treatment by reviewing the pain pattern, surgical history, prior response to treatment, pelvic floor symptoms, bowel and bladder symptoms, hip and SI joint mechanics, nerve pain features, and central pain contributors.
Pelvic floor dysfunction is common in many chronic pelvic pain patterns. When the body experiences ongoing pelvic pain, the pelvic floor muscles may tighten, guard, or lose normal coordination. This can contribute to sitting pain, pain with sex, painful bowel movements, urinary symptoms, rectal pain, tailbone pain, or pelvic pressure.
Pelvic floor dysfunction can persist even after endometriosis lesions are treated. For some patients, pelvic floor physical therapy is an important part of care. For others, pain medicine evaluation may help identify whether pelvic floor trigger points, nerve irritation, or sympathetic pain pathways are also contributing.
Endometriosis-related pain can overlap with nerve sensitization. Some patients describe burning, electric, shooting, sharp, tingling, or numb pelvic pain. Others have pain that worsens with sitting, bowel movements, urination, intercourse, movement, or specific positions.
Nerve-related pelvic pain may involve pudendal neuralgia, abdominal wall nerve irritation, scar-related nerve pain, sacral nerve irritation, pelvic nerve sensitization, or sympathetically mediated pain. MPM evaluates the location, sensation, triggers, prior procedures, pelvic floor findings, and neurologic symptoms to determine whether nerve-targeted care may be appropriate.
Endometriosis can be associated with bowel or bladder pain, especially when symptoms flare around the menstrual cycle. Pain with bowel movements, constipation, diarrhea, bloating, urinary pain, bladder pressure, and lower abdominal pain may all overlap with pelvic pain.
These symptoms require careful evaluation because they may also reflect GI, urologic, pelvic floor, abdominal wall, or nerve-related conditions. MPM does not replace gastroenterology or urology when those evaluations are needed. Instead, MPM helps assess whether pain pathways are contributing to ongoing symptoms after serious or organ-specific causes have been considered.
Pelvic pain may also overlap with hip and musculoskeletal conditions. Hip impingement, labral tears, sacroiliac joint dysfunction, anterior pelvic tilt, piriformis syndrome, abdominal wall pain, hernia-related pain, and pelvic instability can all create symptoms that may feel pelvic or gynecologic.
This overlap is especially important for patients with EDS or hypermobility spectrum disorder. Joint laxity, altered mechanics, muscle guarding, and connective tissue differences may contribute to hip pain, SI joint pain, pelvic floor overactivity, and abdominal wall or nerve sensitivity.
MPM evaluates these musculoskeletal contributors as part of the broader endometriosis-related pain picture.
When pelvic pain persists over time, the nervous system can become more sensitive. This process is often called central sensitization. It can make pain feel stronger, spread beyond the original location, or continue even after the visible tissue findings have changed.
Central sensitization does not mean pain is imagined. It means the nervous system has become part of the pain experience. Endometriosis-associated pain may also overlap with fibromyalgia-like symptoms, headaches, abdominal pain, pelvic floor dysfunction, sleep disruption, anxiety around symptoms, and medical trauma.
Pain psychology, biofeedback, pacing, sleep support, and nervous system regulation can be part of care for selected patients. These tools are not replacements for gynecology care. They help address the ways chronic pain affects the body, brain, behavior, and daily function.
Treatment depends on what is driving the pain. Some patients need ongoing gynecology care, hormonal management, endometriosis surgery evaluation, pelvic floor physical therapy, GI care, urology care, or fertility-related support.
From a pain medicine perspective, selected options may include medication management, pain psychology, biofeedback, acupuncture, trigger point injections, pelvic floor trigger point injections, pudendal nerve block, ganglion impar block, superior hypogastric plexus block, sacroiliac joint injection, sacrococcygeal ligament injection, sympathetic blocks, lumbar sympathetic blocks, ultrasound-guided injections, ketamine therapy, lidocaine and ketamine infusions, or peripheral nerve stimulation.
These treatments are not routine for every patient with endometriosis. They are considered only when the diagnosis, anatomy, pain pattern, severity, risk profile, and goals support them.
Endometriosis requires appropriate gynecologic evaluation. Patients may need imaging, hormonal management, medical therapy, laparoscopy, excision consultation, fertility evaluation, or surgical care depending on symptoms and goals.
MPM does not treat endometriosis lesions directly and does not replace endometriosis surgery when surgery is indicated. MPM’s role is to help evaluate and manage the pain pathways that may overlap with endometriosis, especially when symptoms persist, become chronic, or involve nerve, muscle, joint, abdominal wall, or central pain contributors.
Patients should seek urgent evaluation for sudden severe pelvic or abdominal pain, fainting, fever, vomiting, heavy bleeding, pregnancy with pelvic pain, suspected ectopic pregnancy, blood in stool or urine, inability to urinate or pass stool, rapidly worsening symptoms, new neurologic deficits, signs of infection, or severe pain that feels different from prior episodes.
Pain procedures should not replace appropriate gynecologic, emergency, urologic, GI, surgical, neurologic, or oncologic evaluation when those are needed.
MPM approaches endometriosis-related pain through a diagnosis-first, coordinated model. The goal is to understand whether pain is related to pelvic floor dysfunction, nerve irritation, abdominal wall pain, hip or SI joint mechanics, bowel or bladder overlap, scar tissue, sympathetic pain, central sensitization, or other contributors.
For patients looking for endometriosis pain treatment in Manhattan, MPM offers a careful pain medicine perspective focused on source-finding, patient education, symptom validation, and coordinated treatment planning. Care is individualized and may involve conservative strategies, pelvic floor coordination, pain psychology, biofeedback, medication management, selected image-guided procedures, nerve blocks, or referral to the appropriate specialist when needed.
