Women's Causal Beliefs About Their Pelvic Pain: A Systematic Review and Meta-Ethnography

This study identified and synthesized the current qualitative literature on women's causal beliefs about their chronic pelvic pain.

Academic databases and relevant gray literature sources were searched from their inception to August 2025 with an English language limiter. Study quality was assessed using the Critical Appraisal Skills Programme (CASP) qualitative checklist. A meta-ethnography was used to synthesize findings.

Thirty studies including 1255 women from a range of countries were deemed eligible for inclusion. Seven studies fully met the CASP criteria and were deemed to have minimal risk of bias. The quality of reporting and demographic diversity of included studies were limited, often lacking consideration of researcher-participant relationships, and primarily including Caucasian, cis-gender, heterosexual women from Western countries. Four themes were generated: (1) It's happening to me because I'm a woman, (2) It's happening to me in my body, (3) It's happening to me due to my actions, and (4) It's happening to me due to my life. Women's pain attributions varied from siloed biological, psychological, or social explanations to combinations of these factors. Their perceptions of control also ranged from feeling entirely powerless to experiencing a sense of personal agency. A conceptual model was developed to represent the range of beliefs women hold about the cause of their pelvic pain.

Understanding women's causal beliefs about their chronic pelvic pain may inform clinical assessment to provide a foundation for recovery. This study was unfunded and was preregistered on Open Science Framework (https://osf.io/wkc5v/) and PROSPERO (CRD42023444018).