The Blunt Truth About Medicinal Marijuana and Pelvic Pain

In Pelvic Floor Physical Therapy by Shannon Pacella10 Comments

By Shannon Pacella, DPT, PHRC Lexington


Medical marijuana. You’ve probably heard of it. You’ve maybe even used it. But what you might not know about is the tug-of-war going on between researchers and lawmakers, and how this impacts the ability of this stigmatized substance to be studied – potentially missing out on an alternative treatment option for a multitude of health issues, including pelvic pain.


Let’s start with a little background history. The two main cannabinoids (compounds) from the marijuana plant that are of medical interest to researchers are THC and CBD. CBD is a cannabinoid that is considered non-psychoactive (although it may reduce anxiety), while THC does have psychoactive properties.1 In 1970, the United States Congress placed marijuana in Schedule I of the Controlled Substances Act (CSA).2 According to the United States Drug Enforcement Administration (DEA), “Schedule I drugs, substances, or chemicals are defined as drugs with no currently accepted medical use and a high potential for abuse.”3 Sounds pretty harsh, right? Well fast-forward to present day where currently 25 states plus Washington D.C. have legalized the use of medical marijuana, and 16 other states have legalized non-psychoactive medical cannabis (CBD extract).2 Each state has specific parameters regarding the amount and forms that are considered legal.




The huge disparity between each state’s rules and regulations makes medical marijuana a complicated substance to not only obtain for personal use, but also for researchers looking to further expand what is currently known about marijuana and it’s potential benefits. On August 11, 2016, the U.S. DEA declined to move marijuana from Schedule I to a less-restrictive schedule under the CSA, but has begun the process of allowing more research to be done. The U.S. DEA has created a policy to expand the amount of DEA-registered marijuana manufacturers in order to adequately supply researchers.3




Even though there is tight regulation on the ability to conduct research regarding medical marijuana, the limited findings have yielded great results. THC has been proven to increase appetite and reduce nausea, so the FDA has approved THC-based medications for these purposes (dronabinol and nabilone).1 There have been a number of studies revealing the powerful effects that medical marijuana can have on pain as well. A patient survey of medical cannabis users (for chronic pain) revealed, “average pre-treatment pain on a zero to ten scale was 7.8, whereas average post-treatment pain was 2.8, giving a reported average improvement of 5 points. This translates to a 64% average relative decrease in pain. Others reported therapeutic benefits included relief from stress/anxiety (50% of respondents), relief of insomnia (45%), improved appetite (12%), decreased nausea (10%), increased focus/concentration (9%), and relief from depression (7%).”4 A number of studies have also revealed that medical marijuana can reduce neuropathic pain (something that many people with pelvic pain, including pudendal neuralgia may encounter).5,6,7 Another study looked specifically at men with chronic prostatitis/chronic pelvic pain syndrome who used marijuana.8 The men self-reported in person (clinic) and online. “38.6% of clinic and 75% of online respondents reported that it improved their symptoms. Most of the respondents reported that cannabis improved their mood, pain, muscle spasms, and sleep.”8 You can learn more about male pelvic pain disorders here. Cannabis is also listed as a therapeutic pharmacological treatment for endometriosis, which you can learn more about here.


Another major topic is the relationship between medical marijuana and opioid use. The Centers for Disease Control (CDC) has presented that prescription opioid overdoses have killed more than 165,000 Americans between 1999 and 2014.9 On the other hand, the CDC has reported zero deaths from marijuana overdose ever. Interestingly enough, a study published in 2014 revealed an intriguing trend: from 1999 – 2010, states that allowed medical marijuana use had an average of almost 25% fewer opioid overdose deaths each year than states where cannabis remained illegal.10 Migrating away from prescription opioid use in favor of medical marijuana for pain relief may be the way of the future.




On top of all of these great discoveries is another surprise. All of the 2016 presidential candidates can agree on something: the support of medical marijuana and the need to continue to conduct research on it. Hillary Clinton stated in an interview with Boston’s WBZ radio, “I do think on the federal level we need to remove marijuana from the Schedule I of drugs, move it to Schedule II, which will permit it to be the basis for medical research because it’s important that we learn as much as possible. And since it was a Schedule I drug we haven’t done that research. A lot of experts in the field are telling me we’ve got to learn a lot more.”11 Similarly, in an interview with Bill O’Reilly, Donald Trump said, “I do want to see what the medical effects are. I have to see what the medical effects are and, by the way — medical marijuana, medical? I’m in favor of it a hundred percent.”11


This recent push towards allowing and encouraging medical marijuana use and research will open the door to many more possibilities in alternative treatment options for a variety of medical conditions including chronic pain and neuropathic pain.


This topic is now finally being openly discussed by many medical professionals, including at the International Pelvic Pain Society conference. While attending this conference, I heard Dr. Allan Frankel give a lecture discussing utilizing cannabis for managing pain, anxiety, and sleep. To hear him summarize this presentation, click here (you can skip to 26:30). I’m interested to hear your thoughts and opinions on medical marijuana – what do you think about it? Any personal experiences with using medical marijuana for pelvic pain? You are welcome to share below in the comments!





  1. National Institute on Drug Abuse. Drug facts: is marijuana medicine?
  3. United States Drug Enforcement Administration.
  4. Webb CW, Webb SM. Therapeutic Benefits of Cannabis: A Patient Survey. Hawai’i Journal of Medicine & Public Health. 2014;73(4):109-111.
  5. Wilsey B, Marcotte T, Deutsch R, Gouaux B, Sakai S, Donaghe H. Low-dose vaporized cannabis significantly improves neuropathic pain. J Pain. 2013;14(2):136-48.
  6. Ware MA, Wang T, Shapiro S, et al. Smoked cannabis for chronic neuropathic pain: a randomized controlled trial. CMAJ. 2010;182(14):694-701.
  7. Wilsey B, Marcotte T, Tsodikov A, et al. A randomized, placebo-controlled, crossover trial of cannabis cigarettes in neuropathic pain. J Pain. 2008 Jun;9(6):506-21.   
  8. Tripp DA, Nickel JC, Katz L, Krsmanovic A, Ware MA, Santor D. A survey of cannabis (marijuana) use and self-reported benefit in men with chronic prostatitis/chronic pelvic pain syndrome. Canadian Urological Association Journal. 2014;8(11-12):901-905.
  9. Centers for Disease Control and Prevention.
  10. Bachhuber MA, Saloner B, Cunningham CO, Barry CL. Medical cannabis laws and opioid analgesic overdose mortality in the United States, 1999-2010. JAMA Intern Med. 2014;174(10):1668-1673.
  11. Marijuana Policy Project. Where do they stand on marijuana policy?


  1. I’m a medical marijuana patient and daily user for about 4 years. I’ve had pelvic floor problems for a around a year. Specifically a tight pelvic floor. Marijuana, while helpful for the anxiety and stress that come with the condition, actually seems to tighten my pelvic floor up more and increases my symptoms (specifically the urgency and frequency), a few other people in forums have reported similar experiences. I’m working on stopping because of this and wouldn’t recommend marijuana to most people with a tight pelvic floor.

    1. Author Shannon Pacella says:

      Thank you for sharing your experience regarding marijuana use and pelvic and urinary dysfunction. Medical marijuana, just like other more traditional types of medications may affect people differently. There are many different types of medical marijuana (containing different ratios of CBD and THC), which can alter what types of symptoms it may help with. Dr. Allan Frankel, whom is discussed at the end of my blog post, is currently doing research regarding the different ratios of cannabinoids and how they may affect people differently. Hopefully with the push for more research on medical marijuana, we can get more evidence discussing the relationship between different types of marijuana and it’s affect on the pelvic floor and pelvic pain. Regarding your urinary urgency/frequency symptoms and tight pelvic floor, you might consider seeing a pelvic floor physical therapist for an evaluation, if you have not already done so.

      Thank you again for sharing your experience.


      1. I’ve had vulvodynia for many years now, and, although vaping cannabis does help me with my insomnia, anxiety and other bodily pain, I have found it aggravates my pelvic pain, which, to say the least, is very aggravating! 😉 I am also considering weening off, but I am wondering first if taking cannabis in other ways (oils, edibles, tinctures) might take care of the problem (i.e., perhaps the vape smoke is the aggravating factor) or if there are specific strains that are best for pelvic pain (I also seem to have developed interstitial cystitis and possible IBS). Any thoughts would be helpful- thanks!

        1. Author Shannon Pacella says:

          Hi Ilsa,
          If you live in a state where medical cannabis is legal, I would suggest talking with a physician who grants medical cannabis cards/prescriptions. Dr. Allan Frankel, whom I mentioned in my blog post, has some good resources and information regarding the best ways to use medical cannabis to treat specific conditions. You may find this post from him about medical cannabis and interstitial cystitis helpful:
          I would also suggest getting an evaluation from a pelvic floor physical therapist who can help to address your pelvic pain, interstitial cystitis and possible IBS related symptoms.

    2. If I had to guess that’s the THC. My pelvic/bladder area hated it. I found a brand that is pure CBD, and then had no problems.

  2. Hi Shannon,
    I am 49 years old and have been suffering from chronic pelvic pain and nerve damage for 12 years. I have been taking maximum levels of opiods that can be prescribed for the past 5 years and taking opiods for more than 11 years. Last week my doctor discussed possibly trying medical marijuana to help with this debilitating pain/condition. I have been reading what I can online about the “benefits” of medical marijuana. My concerns/fears of this include withdrawals from opiods, fear of getting high from the marijuana as when I previously tried smoking marijuana as a teenager it made me extremely paranoid, not actually getting any pain relief and possible adverse side effects of this.
    What would you recommend as a starting dosage based on what I described above? And what would you recommend to help with my fears and concerns?
    Thank you for your article.

    1. Author Shannon Pacella says:

      Hi Parry,
      The two main cannabinoids (compounds) from the marijuana plant are THC and CBD. CBD is a cannabinoid that is considered non-psychoactive (although it may reduce anxiety), while THC does have psychoactive properties. I would suggest talking with the physician who mentioned trialing the medical marijuana (cannabis) in regards to the starting dosage and the ratio/amount of THC and CBD in the particular type of medical cannabis you may try.
      I would also suggest getting an evaluation from a pelvic floor physical therapist who can help to address your chronic pelvic pain.

  3. I have been battling chronic pelvic pain /PN for almost two years. I medicate at night with 20mg cannabis/coconut oil capsules. Any high is slept off. I have also found that cannabis/coconut oil suppositories (used vaginally or rectally) work exceptionally well in relaxing the pelvic floor muscles with no psychoactive effects. They can be used during the day and at night. Cannabis is not a one size fits all and one really needs to spend time researching what works best for them.

  4. I am a 55 year old male, whom five years ago began presenting with a urologic/defecation dilemma.
    To this day, drs have been unable to diagnose why, and none of their medicines are helping with pain or function; (exception being Tamsulosin to help relax the urethra sphincter).
    I read about how cannabis might help, and it did. I’ve been medicating myself in the evening with a small amount, that has helped immensely with the pain associated with the disability of being able to do #2 normally, and contrary to others with pelvic disorders, med marijuana actually decreases the bloating and relaxes my lower quadrant.

  5. Shirley, what formulation of cannabis suppository are you using-THC, or CBD and THC? Where do you get them? I have never seen them in AZ. I have been using Valium suppositories for my pelvic floor dysfunction but it makes me sleepy and would rather try cannabis since it works so well for me with very little side effects.

    I have been using medical cannabis for about a year for my pelvic pain and it is amazing. I prefer the CBD since it does not have the psychoactive effects, does not make me sleepy, is much cheaper ($40/bottle), and you do not need a medical card to purchase it. For more moderate pain the 2:1 CBD:THC oral tincture ($100/bottle) is what I have been using and it is incredible. It starts working in 15 minutes and the pain is tolerable or sometimes even gone within 30 minutes. The only side effect I have is sleepiness. When I told my surgeon about it she suggested I continue to use it since it would help my pelvic floor dysfunction/nerve pain, and it does. Thanks for doing this piece. I really think many patients could benefit from cannabis use for their pelvic pain.

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