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Centre for Pelvic Pain & Endometriosis

We are one of the few tertiary care Centres of Excellence in Canada for the management of endometriosis and pelvic pain.
What we do

We offer an interdisciplinary approach to chronic pelvic pain that includes a combination of pain education workshops, pelvic floor physiotherapy, clinical counselling, medical management and surgery (including advanced excisional laparoscopic surgery).

We regularly conduct our own research on pelvic pain and endometriosis, ensuring that the care we provide is the most advanced, effective, and evidence-based care that exists.

We help women with chronic pelvic pain find a diagnosis, get started on treatment and improve their quality of life, function, and well-being. Women with pelvic pain can live very happy, healthy lives!

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Finding a diagnosis for pelvic pain

This examination, done gently, helps to locate tender areas. We call these tender areas trigger points which are areas where the muscles and the nerves in the skin may be involved.


Pain mapping has proven to be very helpful in showing the sources of pain caused by endometriosis, by finding tender areas in the uterus, ovaries, bladder, or peritoneum. Pain mapping also helps to assess sources of pain from causes other than endometriosis, such as adhesions, ovarian cysts, hernias, musculoskeletal/myofascial conditions, and interstitial cystitis.


An internal (pelvic) exam and endovaginal ultrasound may also be performed to help locate any tender areas in and around the internal organs such as the uterus and ovaries.


At this point your physician will help you explore options for treatment, or may suggest further procedures such as diagnostic laparoscopy, based on your individual situation.

 

Treatment options for pelvic pain

The number one most important thing is to help you learn about what chronic pain is and how it can be not only managed, but in some cases reduced. Many women with chronic pelvic pain also have a condition called central sensitization of the nervous system. Sensitization can be reduced.


Anti-inflammatory dietInitial steps in treatment may involve life-style changes such as following tips in our Endometriosis: An Overview handout, adopting an anti-inflammatory diet, establishing an exercise routine, and exploring ways to reduce stress. Pain reducing medications may be suggested, but should be used cautiously to avoid side effects.


Visit health information for patients for resources for women experiencing chronic pelvic pain.

 

Medications

Medical treatment may involve the use of hormones to stop ovulation and the fluctuations in hormone levels (in particular, estrogen levels) as well as stopping menstruation. Though hormonal treatments can be a very useful tool, for some they may not be effective, may be too expensive, and/or may have unacceptable side effects. As everyone responds to hormone treatment in their individual way, careful monitoring with our physicians helps ensure a better outcome.


Medications that may help with pain by reducing or preventing bleeding and ovulation may include:


  • Combinations of estrogen and progesterone such as birth control pills or patches that can be used either cyclically or continuously
  • Progestin-releasing intrauterine devices such as Mirena® IUD or Kyleena® IUD 
  • Progestin medications such as dienogest or norethindrone acetate
  • Medications that decrease estrogen levels such as GnRH agonists or antagonists (eg. leuprolide acetate, elagolix, relugolix)
 

There are many different types of surgery for pelvic pain and endometriosis. In most cases surgical treatment is done by laparoscopy, through a set of small incisions in the abdomen. Laparoscopy can be used both to diagnose and to treat certain pelvic pain conditions. Our gynaecologists are specialists in advanced minimally invasive excisional laparoscopy.


Laparoscopic surgery 


Advanced minimally invasive laparoscopy for excision of endometriosis Laparoscopy is usually a day surgery, but may require hospital admission for more severe cases. The goals of surgical treatment are to be minimally invasive, to provide long-term relief, and to conserve your ability to become pregnant. Our surgeons remove the tender areas of endometriosis on the peritoneum and allow healthy tissue to form during healing. This is reconstructive surgery that does not affect the function of the ovaries, fallopian tubes, or uterus and that can enhance fertility and decrease pelvic pain.


In some women, when fertility is not a concern, removing the uterus and/or ovaries with a hysterectomy may be an option, so as to obtain better long-term relief of symptoms. This is discussed with you on an individual basis.

 

Some of the ongoing pelvic pain you are experiencing may be related to joint or muscle dysfunction. A physiotherapy screening assessment is helpful in identifying any issues of this nature.


Issues that may arise in physiotherapy assessments:

  • Pelvic girdle pain (PGP) that can involve the low back, hips and pubic bone area, characterized by pain with sustained positions, e.g. sitting or standing for long periods or when changing positions e.g. turning over in bed and standing up from a seated position
  • Vaginal and vulvar pain during vaginal penetration with sexual intercourse or vaginal examination and tightening/spasm of the pelvic floor muscles which can make deeper penetration very painful, very restricted or even not possible
  • Bladder and bowel issues with full bladder, leakage of urine, gas, bowel movement constipation, diarrhea, irritable bowel syndrome, pain with bowel movement
  • Allodynia which is pain with light touch - a sign of a very sensitive nervous system
  • Decreased activity and difficulty getting started with an activity and with flare ups with activity

Physiotherapy treatment may include:

  • Education about chronic pain and about specific issues identified during the assessment
  • A combination of manual therapy, stretching, and coordination exercises to work towards muscle balance and good functioning
  • Manual therapy for hands-on assessment and treatment, joint movement, and soft tissue stretching
  • Body mechanics education for good posture and movement through your daily routine
  • Muscle balancing with stretches, coordination exercises, and relaxation/strengthening exercises
  • Behavioural modification for urinary issues to help calm the bladder urges and increase the time between urination
  • Bladder and fibre diaries to record fluid or fibre intake, time and volume of urination, and urine leakage
  • Temporary diet eliminations of potential bladder irritants
  • Pelvic floor coordination exercises to help learn how to contract, hold, and relax the pelvic floor correctly and on demand. The focus is usually on learning how to relax the pelvic floor
  • Relaxation with the use of body scans and breathing
  • Planning a strategy to start an exercise program that is manageable and below the flare-up level

Tools often used in physiotherapy treatment:

  • EMG biofeedback: A tool that uses sensors external to the vagina, to detect muscle activity which is shown on a computer screen, which can be used during assessment and treatment
  • Imaging ultrasound: A tool that shows abdominal and pelvic floor muscles and their motion on a screen which can be used during assessment and treatment to help with core muscle coordination

Active lifestylePhysiotherapists can work with women with pelvic pain to assess and provide treatments to correct muscle and joint function, posture, and body mechanics. They can teach you how to begin and progress through participation in daily activities and exercises, how to improve bowel and bladder issues, and techniques for decreasing tension and sensitivity.


You can learn techniques for general relaxation, breathing, general movement and stretches that will not cause pain, and posture that will break unhelpful patterns. You can develop tools that will help you manage your pain and increase your activity.

 

Chronic pelvic pain is a complex issue, one that affects all aspects of a woman's life.If you are experiencing chronic pelvic pain, then you are likely very aware of all the areas in your life that can be affected such as work, school, physical activities, relationships, and sexual function. Chronic pain can also affect mood, thoughts, behaviour, and stress levels.


Effective treatment for chronic pelvic pain must include an interdisciplinary approach that pays attention to the psychosocial and emotional aspects of pain by providing counselling and emotional support in addition to the surgical, medical, and mechanical treatment approaches.


Counselling can help you cope with chronic pelvic pain by:

  • Learning mindfulness-based techniques to help reduce stress and chronic pain
  • Helping to manage intense emotions and negative thoughts
  • Learning tools to help calm the nervous system and to reduce central sensitization
  • Practising ways to make lasting lifestyle changes, including diet and physical activity
  • Finding ways to increase communication and support in relationships
  • Grieving the many pain-related losses
  • Addressing symptoms of anxiety, depression, or trauma that may coincide with chronic pelvic pain
  • Making decisions regarding fertility and surgery options

Our counsellor can also help you access community and online resources for chronic pain, mental health, and wellness. Visit the health information for patients section for resources for women experiencing chronic pelvic pain.


Appointments

How to make an appointment

A doctor’s referral is required to enter our program. You can download a Referral Form and/or have your physician fill it out and fax it to us at 604-875-2569. If you are already a patient of our program, you can call 604-875-2534 to make an appointment.

Wait times to get an appointment

Our wait times have been impacted by service delays due to COVID-19.  Our average wait time for the Chronic Pain and Endometriosis program is currently 9-12  months but may fluctuate. A letter will be sent back to your referring doctor once the referral is accepted and will include the most up to date wait time.  Please ensure that the information in your referral package is complete which will help our team to appropriately triage and schedule the initial appointment.

Once your referral is accepted, you will have an assessment by one of our gynaecologists who specializes in chronic pelvic pain and who will discuss your treatment plan with you.


We are an interdisciplinary program. Your care may include any combination of medications, surgery, physiotherapy, counselling, and pain education workshops.


Most women complete the program within 6 to 12 months. After the program is completed, you will be returned to the care of your family physician. Your family physician will be able to consult with our gynaecologists, should the need arise.


Please note that as a provincial teaching centre, we often have gynaecology fellows and residents participating in your care.

 
We focus on the assessment and treatment of women of reproductive age (e.g., 16 to 55 years) who are living in BC and experiencing chronic pelvic pain and/or endometriosis.

Our goal is to provide comprehensive care for those who we believe would benefit the most from our gynaecological expertise and interdisciplinary approach.

As a result, we are unable to provide services to patients whose primary concern consists of: 
  • neuropathic pain, myofascial pain, back pain, vulvodynia, vulvar vestibulodynia, or urogynecological complications (e.g., mesh, tape, continence procedures, prolapse, etc.).
  • We are also unable to provide services to those outside of our stated age range (e.g., postmenopausal) or
  • who are not residents of BC.
 

Our team

Gynaecologists

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Dr. Catherine Allaire (MD, FRCSC) is the Medical Director of the BC Women's Centre for Pelvic Pain and Endometriosis.  Dr. Allaire is Clinical Professor at UBC Department of Obstetrics & Gynaecology and Head of the Division of Gynaecologic Specialties. She is also the creator and past director of the ObGyn residency MIS rotation and is the co-Director of the UBC Advanced Training Program in Endometriosis, Pelvic Pain, and Advanced Laparoscopy.

 

Dr. Allaire graduated with honours from McGill University then moved to Vancouver to pursue specialty training in Obstetrics & Gynecology at University of British Columbia. She followed with a Fellowship in Minimally Invasive Surgery (MIS) at Baylor College of Medicine in Texas.  Dr. Allaire brought her specialised skills back to Canada and was an early adopter and teacher of minimally invasive surgical techniques (MIS) for the treatment of gynaecologic problems, such as laparoscopic hysterectomy and laparoscopic excision of complex endometriosis.

She co-founded (with Dr. Williams) the BC Women's Centre for Pelvic Pain and Endometriosis  in 2011 to offer interdisciplinary, evidence-based, and innovative care for our patients.  She has a passion for her work, but in her time off loves to ski and cycle.

 

Dr. Allaire is active in research related to gynaecology and pelvic pain, including the creation of the WERF EPHect Tools. As a member of the Society of Obstetricians & Gynecologists of Canada (SOGC), Dr. Allaire has participated in creating many national guidelines on benign gynecologic conditions, including  Chronic Pelvic Pain (lead author) and Endometriosis.  She was President of the World Congress on Endometriosis in 2017. She has held many leadership positions in national and international societies, including CanSAGE, WES, and IPPS. She is also involved in advocacy through EndoACT Canada.






 

Williams_Christina.jpgDr. Christina Williams (MD, FRCSC) is a Gynaecologist at the BC Women's Centre for Pelvic Pain & Endometriosis.  Dr. Williams was born in Barcelona, Spain where she graduated from University of Barcelona in 1981. Dr. Williams completed her Residency in Obstetrics & Gynecology in 1987 at University of British Columbia. During the 8 years she served as an Obstetrician/ Gynecologist in Langley, she developed a strong interest in assisting women with chronic pain and  endometriosis-related infertility.


Since completing a Fellowship in Reproductive Endocrinology and Infertility at the University of British Columbia in 1998, Dr, Williams has served as a member of the Division of Reproductive Endocrinology and Infertility and Medical Director of the BC Women's Centre for Reproductive Health (REI/IVF). Through Dr. Williams' advocacy efforts, the interdisciplinary Centre for Pelvic Pain & Endometriosis was created in 2011.


Dr. Williams' practice involves helping women with pelvic pain, endometriosis, infertility, menstrual disorders, fibroids, and recurrent pregnancy loss. Her expertise is in pelvic ultrasound and advanced surgical management of gynecological conditions, such as laparoscopic removal of fibroids, laparoscopic excision of complex endometriosis, and laparoscopic hysterectomy.


As Clinical Associate Professor in the UBC Department of Obstetrics & Gynaecology, Division of Gynaecologic Specialties, Dr. Williams is an active clinical and surgical teacher of residents and fellows. She devotes a large portion of her practice to research in the diagnosis and management of chronic pelvic pain and endometriosis.

 

Dr. Paul Yong (MD, PhD, FRCSC) is a Gynaecologist at the BC Women's Centre for Pelvic Pain & Endometriosis and has been with the program since it began in 2011. Dr. Yong's clinical practice is focused on pelvic pain, with a particular interest in endometriosis, painful periods, sexual pain, co-existing bladder and bowel problems, and pain related to the musculoskeletal system. His surgical interests include laparoscopic excision of complex endometriosis and prevention of adhesions in women with endometriosis and pelvic pain and infertility.


Dr. Yong completed a MD/PhD degree in Experimental Medicine and a Residency in Obstetrics & Gynaecology, followed by a Clinical Fellowship in Endometriosis, Pelvic Pain, & Advanced Laparoscopy in 2012, at the University of British Columbia.


Dr. Yong directs the Research Program at the BC Women's Centre for Pelvic Pain & Endometriosis. His clinical research interests are in endometriosis and pelvic pain, and his translational research interests include bio-banking of endometriosis, gene sequencing in endometriosis, and investigating nerve formation in the pelvis as a cause of pain. Dr. Yong is also involved in teaching and is Assistant Professor in the UBC Department of Obstetrics & Gynaecology, Division of Gynaecologic Specialties.

 

Bedaiwy_Mohamed.jpgDr. Mohamed Bedaiwy (MD, FRCSC) joined the BC Women's Centre for Pelvic Pain & Endometriosis in 2015. He is also Professor and Division Head, Division of Reproductive Endocrinology & Infertility, UBC Department of Obstetrics and Gynaecology. Dr. Bedaiwy received his medical degree from Assiut University School of Medicine in Egypt, where he graduated Valedictorian, summa cum laude. 


Dr Bedaiwy completed a residency in Obstetrics and Gynecology at the University Hospital Case Medical Center, CWRU, in Cleveland, Ohio; a fellowship in Reproductive Endocrinology and Infertility at the University Hospital Case Medical Center, CWRU, in Cleveland, Ohio; a fellowship in Minimally Invasive Surgery at the Cleveland Clinic Foundation in Cleveland, Ohio; a fellowship in Reproductive Endocrinology and Infertility in the Division of Reproductive Sciences at University of Toronto; and a PhD from the University of Maastricht in the Netherlands for his work on ovarian tissue cryopreservation and transplantation.


Dr. Bedaiwy is a prolific author with over 200 publications, including 104 peer-reviewed publications. He is best known for his work in endometriosis, ovarian transplantation, in vitro fertilization (IVF) and minimally invasive surgery (MIS). His interests include IVF, MIS, robotic surgery, fertility preservation in cancer patients, and endometriosis. He is also the Associate Editor of Human Reproduction, which is the official journal of the European Society of Human Reproduction and Embryology (ESHRE). Dr. Bedaiwy has had a career-long interest in high quality medical care, research and education. His research interests include IVF, MIS, robotic surgery, fertility preservation in cancer patients, and endometriosis.

 

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Dr. Caroline Lee (MD, MSc, FRCSC) is a Gynaecologist at the BC Women's Centre for Pelvic Pain & Endometriosis.  Dr. Lee completed her medical degree at the University of Alberta and her residency in Obstetrics and Gynaecology at the University of Saskatchewan. She joined the BC Women’s Centre for Pelvic Pain & Endometriosis after completing her fellowship in Endometriosis, Pelvic Pain & Advanced Laparoscopy and Masters in Reproductive Sciences at the University of British Columbia in 2020.

Dr. Lee’s primary clinical practice involves diagnosis and treatment of pelvic pain, endometriosis, co-existing pain syndromes, and complex surgical management. She has a strong clinical interest in the use of ultrasound and magnetic resonance imaging to aid in clinical diagnosis and planning prior to surgical management. She has played a central role in collaborative efforts with the department of radiology including leading regular radiology rounds for patients with complex gynaecological pathology and implementation of the sliding sign initiative at Vancouver General Hospital/University of British Columbia.

As a Clinical Associate Professor in the UBC Department of Obstetrics & Gynaecology, Division of Gynaecologic Specialties, Dr. Lee is an active clinical and surgical teacher of residents and fellows. She is currently acting as the director for the Advanced Training Program in Endometriosis, Pelvic Pain and Advanced Laparoscopic Surgery and director for the Chronic Pelvic Pain/ Minimally Invasive Surgery residency rotation.


 

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Dr. Tinya Lin (MD, MSc, FRCSC) is a Gynaecologist at the BC Centre for Pelvic Pain & Endometriosis. Dr. Lin completed medical school at the University of Western Ontario, followed by residency in Obstetrics and Gynecology at the University of Calgary. She also completed a M.Sc in International Healthy Policy at the London School of Economics, and fellowship in Endometriosis, Pelvic Pain, and Advanced Laparoscopic Surgery at the University of British Columbia. 

 

Dr. Lin's clinical practice is primarily focused on chronic pelvic pain and endometriosis. She has particular interest in use of pelvic ultrasound and advanced laparoscopy in complex benign gynecologic conditions. She actively participates in teaching residents and fellows at the University of British Columbia, and is involved in academic research that aims to improve the lives of those affected by pelvic pain. 


 

Nurse


Victoria Martin is a Registered Nurse at BC Women's Centre for Pelvic Pain & Endometriosis. She completed her nursing program at British Columbia Institute of Technology with a specialty in Perinatal Nursing. Victoria has over 20 years experience in women's health care working in several clinics at BC Women's including Labour & Delivery, Recurrent Pregnancy Loss, Breast Health, Reproductive Endocrinology & Infertility (REI/IVF) and Pelvic Pain. Victoria is passionate about comprehensive health care for women with an emphasis on conditions unique to women such as reproductive health, sexual health, and pelvic pain. She has a strong interest in research related to women's health care.

 
 

Physiotherapist


Weaver_Becky.jpgRebecca Weaver is a registered physiotherapist with a Master’s degree in physiotherapy from Queen’s University in 2006. Since graduating, Rebecca has worked primarily as a pelvic health therapist in both public and private practice.  Her role at the BC Centre for Pelvic Pain and Endometriosis is educating, assessing, and treating patients with pelvic girdle pain, bowel and bladder dysfunction, and sexual pain. Rebecca enjoys co-teaching the patient education workshop and also seeing patients one-on-on both over Zoom and in person. She is thrilled to be part of the wonderful team here at the CPP program. In her spare time, she loves being with her family - skiing in the winter, and kite surfing or camping in the summer.Content

 

 Counsellor

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Ria Nishikawara (she/her) is a registered clinical counsellor (RCC) providing individual and group counselling to adults. Since completing her Master’s degree in Counselling Psychology at the University of British Columbia she has worked primarily with people living with chronic pain, chronic illness and those recovering from trauma-related conditions. She has worked in healthcare since 2010 and has a background in crisis intervention, substance use, and identity-related difficulties. Ria is also in the process of completing a PhD in Counselling Psychology, and her research focuses on the working relationships between gender and sexual minority patients with endometriosis and gynaecologists. 




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