Dr. Lara Quintas Marquès Gynecologist specializing in endometriosis and chronic pelvic pain in Barcelona

When the pain affects your life: if you miss work or school because of your period, if you need painkillers every month, if you have pain during sex, when urinating or when having a bowel movement, or if you have had pelvic discomfort for more than six months. Period pain that is disabling is not normal, and the diagnosis of endometriosis is still delayed by several years on average. In addition, the longer pain goes untreated, the greater the risk that the nervous system becomes sensitized and the pain becomes chronic.

It takes longer than a routine gynecology visit, because the most important part is the medical history: when the pain started, what it is like, what makes it worse, how your bowel and bladder work, how you sleep and which treatments you have tried. Then I do a careful examination, including an assessment of the pelvic floor muscles, and a gynecological ultrasound. You leave with a working diagnosis and a written plan.

Not always. Surgery is one more tool, not the first step. For many patients, hormonal treatment, pelvic floor physical therapy and specific pain treatment are enough to regain their quality of life. Surgery is considered when there is a clear indication: lesions affecting other organs, lack of response to or intolerance of medical treatment, or some cases where pregnancy is desired. The decision is made together with you, after explaining the benefits and risks of each option.

Because a normal ultrasound or MRI does not rule out a real problem. Chronic pelvic pain can have a muscular origin (myofascial pelvic floor pain) or a nerve origin (for example, pudendal nerve entrapment), or it can be due to central sensitization, a process in which the nervous system amplifies pain signals. None of this shows up on an imaging test: it is diagnosed with a good medical history and a targeted examination.

Yes, and in chronic pelvic pain it is essential. Depending on what you need, I coordinate treatment with specialized pelvic floor physical therapy, pain clinics, gastroenterology, urology, psychology and sex therapy. Chronic pain cannot be solved by a single specialty.

I see patients at two private centers, each with its own access conditions. The most practical thing is to call the center that suits you best, mention your insurance company and ask about your specific case.

Not directly. I am a Senior Consultant Gynecologist in the Endometriosis Unit at Hospital Clínic de Barcelona, but this is public hospital practice: patients are seen through the usual channels of the public health system, by referral from your primary care physician or from another specialist. If you want to book an appointment directly, you can do so at my private practice: Gineclinic or Women's Clínica Ginecológica.

Spanish, Catalan, English and French. I trained in Aix-en-Provence and collaborate with the Centre Hospitalier Universitaire de Nantes, so I can see you in French without any problem.