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.