Normal test results do not mean your pain has no cause. They mean the workup you had was not designed to find it. When a pelvic ultrasound, bloodwork, and a urine culture all come back clean, most providers run out of places to look, which is usually where Dr. Sonia Bahlani's evaluation actually starts.
Dr. Bahlani has built her boutique urology and gynecology practice in New York City around cases exactly like this. After completing her OB/GYN residency, she pursued a fellowship in urology under Dr. Robert Moldwin, a leader in the field of pelvic pain, giving her a rare, dual-trained perspective most providers never develop. That combined training is why she approaches chronic pelvic pain as a problem that often sits between two specialties rather than inside one, which is exactly why it gets missed by a standard workup.
Why Normal Test Results Don't Mean There's No Cause
A standard pelvic pain workup is built to rule out a short list of conditions:
- Infection
- Structural abnormalities visible on imaging
- A handful of hormonal markers
When those come back clean, the workup is considered complete, even though it was never designed to evaluate the tissues most often responsible for chronic pain.
A conventional pelvic workup typically checks:
- Pelvic and transvaginal ultrasound for structural abnormalities
- Basic bloodwork and hormone panels
- Urinalysis and urine culture for infection
- STI screening
What it does not evaluate is:
- The pelvic floor musculature
- The pudendal and other pelvic nerves
- The bladder wall's sensitivity independent of infection
- The vestibular tissue at the vaginal opening
Pain generated by any of these structures will not show up on an ultrasound or in a lab value, no matter how severe it is.
The Gap Between Gynecology and Urology
Most patients with pelvic pain are seen first by a gynecologist, then referred to a urologist, then sometimes to a gastroenterologist, with each specialist evaluating strictly within their own organ system. Pelvic pain rarely respects those boundaries.
A single patient's pain can involve overlapping systems that no one specialist is trained to evaluate together, such as:
- Bladder tissue
- Pelvic floor muscle
- Nerve tissue
A provider trained in only one of these systems will see only part of the picture. This is the gap Dr. Bahlani built her practice to bridge. Her training combined an OB/GYN residency with a fellowship in urology, specifically to evaluate pelvic pain as a single interconnected system rather than a set of separate organs.
What Dr. Bahlani Looks For Once the Standard Workup Comes Back Clean
When a patient arrives with normal imaging and labs, Dr. Bahlani treats it as a signal to examine tissue and function that standard testing cannot capture. Her evaluation targets specific tissues and systems that a standard workup was never designed to assess, including:
- The pelvic floor muscles, checked directly for hypertonicity, trigger points, and asymmetric tension, since a tight or dysfunctional pelvic floor can produce pain that mimics bladder or gynecologic disease
- The vestibule, tested for localized tenderness that points to vestibulodynia, a diagnosis made almost entirely by touch rather than imaging
- The pudendal nerve, evaluated through specific positional and pressure-based testing, since nerve-related pain often has a distinct pattern that labs cannot detect
- The bladder itself, assessed for irritability or inflammation in the absence of infection, which points toward interstitial cystitis rather than a recurring UTI
None of these findings appear on a standard chart. They come from a targeted, hands-on evaluation built specifically around chronic pelvic pain, which is the piece missing from most workups before a patient reaches her practice.
Conditions That Commonly Hide Behind Normal Results
A number of the conditions Dr. Bahlani treats most often are ones that, by definition, do not show up on routine imaging or bloodwork. Patients frequently arrive already having been told there is nothing wrong, when in fact the diagnosis simply requires a different kind of exam.
Conditions she sees repeatedly in patients with previously normal workups include:
Each of these is a clinical diagnosis, meaning it is identified through history, exam findings, and pattern recognition rather than a single test result. That is precisely why patients can spend months or years being told their tests are normal before anyone identifies what is actually happening.
Why This Kind of Evaluation Takes More Than One Visit
A thorough pelvic pain evaluation is not something Dr. Bahlani can complete in a single fifteen-minute appointment, and she does not try to. Patients coming to her after a series of inconclusive workups are usually looking for an answer, not another quick screening that repeats what has already been ruled out.
Her evaluation is built around time, and typically includes:
- A detailed history of when the pain started and how it has changed
- A targeted physical exam of the muscles, nerves, and tissue most often involved
- Imaging repeated with a more specific question in mind, when needed
- A review of the patient's history to identify a triggering event, such as childbirth, a prior surgery, or an infection that resolved but left lingering nerve or muscle changes behind
- Enough follow-up to see how the findings connect once a treatment plan begins
This is a deliberate, comprehensive process rather than a fast diagnostic pass, because chronic pelvic pain is rarely explained by one finding in isolation.
You Deserve a Specialist's Approach to Finding the Cause of Your Pelvic Pain
If your tests have come back normal but your pain has not resolved, a more specific kind of evaluation is in order. Dr. Bahlani's focus on pelvic pain has been recognized well beyond her own practice. She is a recipient of the Marinoff Career Development Award from the National Vulvodynia Association, has presented her research at the International Association for the Study of Pain and the American Urological Association, and has been named to the New York Super Doctors list from 2021 through 2025. She has also authored Dr. Sonia's Guide to Navigating Pelvic Pain, a resource designed to help patients understand conditions that are commonly missed.
Schedule a consultation today to start a thorough evaluation built around your specific history and exam findings, not a repeat of the testing you have already had.
Sources
- Cleveland Clinic – Pelvic Pain , overview of pelvic pain as a symptom and the range of systems it can involve.
- NCBI Bookshelf – Pudendal Neuralgia , clinical reference on pudendal neuralgia as a diagnosis made primarily through history and exam rather than imaging.
- NCBI Bookshelf – Pelvic Floor Dysfunction , clinical reference on hypertonic and hypotonic pelvic floor conditions and their overlapping urologic, gynecologic, and colorectal presentations.
- Mayo Clinic – Interstitial Cystitis , overview of interstitial cystitis as bladder irritability in the absence of infection.
- Henzell H, Berzins K, Langford JP, "Provoked Vestibulodynia: Current Perspectives," International Journal of Women's Health , peer-reviewed overview of vestibulodynia as a clinical diagnosis based on touch-based exam findings.
Disclaimer: This information is provided for educational purposes only and does not replace a consultation with Dr. Sonia Bahlani or another qualified pelvic pain specialist. Findings, diagnoses, and treatment plans vary from patient to patient.
