PURPOSE To describe medical therapeutic options for chronic pelvic pain. Furthermore to describe some new concepts in the etiology of chronic pelvic pain leading to some novel therapies. METHODS The benefits and risks of various medical treatments for chronic pelvic pain including central pain, cyclic pain, vulvar pain and bladder pain are discussed. RESULTS Among various conventional therapies the medical therapy with the most benefit with the least risks are low-dose impeded androgens, oral contraceptives, or low dosage progesterone/progestins. CONCLUSIONS The various types of pelvic pain may all be different manifestations of a common etiology related to defects in the sympathetic nervous system. Sympathomimetic amine therapy may be the most effective therapy with the least side-effects. However, at the moment this schedule II drug has not been approved for this use and thus must be used off-label.