For many patients with chronic pelvic pain, the clinical journey is long and fragmented and too often, delayed by not being fully heard.
Symptoms evolve, consults multiply and diagnoses remain unclear.
On average, endometriosis takes eight to 10 years to diagnose in the United States. In that time, patients may see multiple providers, undergo incomplete evaluations, or be told that their symptoms are normal.
Dr. Courtney Poston, a fellowship-trained specialist in complex benign gynecology at MUSC Women’s Health, sees that pattern regularly.
“A lot of these patients have been told to just tough it out,” she says. “But severe pain and heavy bleeding are not normal. We have to stop treating them that way.”
When symptoms don’t fit a single system
One of the core challenges is that these conditions rarely present cleanly.
Patients may report pelvic pain, but also bowel symptoms, bladder discomfort, fatigue, or irregular bleeding. Those symptoms are often evaluated in isolation, leading to referrals across specialties without a unifying diagnosis.
“They’ll come in with what seem like unrelated symptoms,” Poston says. “But when you understand how these diseases affect multiple organ systems, the pattern becomes clear.”
Without specialized training, that pattern can be difficult to recognize. Many patients are ultimately referred to gastroenterology, urology, or general medicine before gynecologic causes are fully explored.
At MUSC, complex benign gynecology is treated as a defined area of focus rather than a subset of general practice. That distinction shapes both the evaluation and the treatment plan.
The first intervention is belief
For Poston, the most important tool is not surgical. It is clinical validation.
“If someone is coming in and telling you they’re in pain, there’s a reason for that,” she says. “We have to believe patients when they tell us something is wrong. Listening carefully to a patient's story often reveals the diagnosis far before imaging does.”
That mindset changes the consultation itself. Rather than ruling out gynecologic causes early, Poston approaches these cases with the assumption that symptoms may be interconnected and worth investigating fully.
Even when the diagnosis is not immediately clear, the process does not stop.
“I’m not going to rule something out until I’ve ruled it out,” she says.
That may include advanced imaging, longitudinal evaluation, or surgical exploration when appropriate.
A different approach to surgery
That philosophy carries into the operating room.
In many cases, patients with suspected endometriosis undergo a staged process: an initial diagnostic laparoscopy followed by a second surgery for definitive treatment.
Poston aims to avoid that sequence when possible.
“If we strongly suspect endometriosis, the goal is not just to confirm it,” she says. “The goal is to treat it.”
That means excising all visible disease comprehensively during a single procedure rather than subjecting patients to multiple operations.
It also means referring earlier.
Patients with chronic pelvic pain, infertility, complex surgical histories, or suspected deep infiltrating disease are often better served by subspecialty evaluation before any surgical intervention is attempted. "The quality of surgery matters." Poston says. "One meticulous excision surgery is better for the patient and more effective overall than multiple incomplete excisions"
Changing what recovery looks like
When surgery is required, a minimally invasive approach can significantly alter recovery.
At MUSC, the majority of Poston’s patients return home the same day, even after complex procedures. Many begin feeling like themselves again within one to two weeks, with longer precautions tailored appropriately.
That shift reflects more than technique.
It depends on careful patient selection, structured perioperative planning, and a deep understanding of postoperative recovery.
For patients who have often spent years navigating unresolved symptoms, that experience can feel markedly different.
A gap that is still closing
Despite these advances, access remains uneven.
Poston is currently the only fellowship-trained specialist in complex benign gynecology at MUSC. Across many regions, similar gaps persist, contributing to delayed diagnosis and fragmented care.
Expanding subspecialty training and referral pathways will be critical to improving outcomes.
“These patients deserve specialized care,” she says. “And they deserve it early.”
What changes when care is aligned
When patients are evaluated through a subspecialty lens, the impact can be immediate.
The result is a clearer diagnosis, a more deliberate surgical plan, and a recovery that restores function instead of extending uncertainty.
But for many patients, the shift begins earlier than that.
It begins with being heard.
“Diagnosis is part of the treatment,” Poston says. “Just having an answer can be life-changing.”
