Chronic Pelvic Pain

Reported prevalence of chronic pelvic pain among women world-wide varies greatly, with rates of 6% to 27%. There was a lack of agreement on the definition of chronic pelvic pain.

Traditional thinking about chronic pelvic pain has emphasized observable pathology (e.g. endometriosis, adhesions), but the connection between these problems and pain symptoms is actually more tenuous than previously thought.

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Definition

Defined as persistent, noncyclic pain perceived to be in structures related to the pelvis. An arbitrary duration of six months is usually considered chronic.

Evaluation

The International Pelvic Pain Society has developed a detailed history and physical examination form for evaluation of women with chronic pelvic pain. 

Laboratory testing is of limited value in evaluating women with chronic pelvic pain. Transvaginal pelvic ultrasound is helpful in identifying pelvic masses and adenomyosis.

For severe pain, laparoscopy should be considered if the diagnosis remains unclear after the initial evaluation. Laparoscopy may be useful to confirm and possibly treat endometriosis and/ or pelvic/abdominal adhesions.

Possible Causes

  • Endometriosis
  • Adenomyosis
  • Pelvic adhesions
  • Pelvic support disorder
  • Pelvic congestion
  • Residual ovary
  • Ovarian remnant syndrome
  • Musculoskeletal cause
  • Non-gynaecological causes 

Treatment

Chronic pelvic pain represents a complex and nuanced syndrome in which treatment may vary considerably depending on the patient. When pain itself is the disease, the goal of treatment is not necessarily complete eradication of pain, but rather finding strategies that afford more functional living.

This will require multi-disciplinary input and involvement of social support network to provide holistic treatment. 

Lifestyle modification, healthy eating, smoking cessation is integral part of treatment.

Neuromodulatory medications, psychological intervention (eg, cognitive–behavioral therapy, pain psychotherapy, sexual counseling), and complementary strategies (eg, mindfulness-based medication, yoga, acupuncture) can be useful.

Minimally invasive surgery can treat observable pathology such as adhesions, endometriosis or ovarian remnant.

Dr Sem has built a network of expert health professionals to assist him in providing an integrative model of care to his patients.