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Chronic Pelvic Pain

Howard, Fred M. MS, MD

Obstetrics & Gynecology:
Clinical Gynecologic Series: An Expert's View
Abstract

Chronic pelvic pain is a common and significant disorder of women. It is estimated to have a prevalence of 3.8% in women. Often the etiology of chronic pelvic pain is not clear, as there are many disorders of the reproductive tract, gastrointestinal system, urological organs, musculoskeletal system, and psychoneurological system that may be associated with chronic pelvic pain. The history and physical examination are crucial in evaluating a woman with chronic pelvic pain and must address all of the possible systems potentially involved in chronic pelvic pain, not just the reproductive system. Laboratory and imaging studies should be selectively utilized, as should laparoscopy. Conscious laparoscopic pain mapping has been proposed as a way to improve information derived from laparoscopic evaluations. Treatment of chronic pelvic pain may consist of two approaches. One is to treat chronic pain itself as a diagnosis, and the other is to treat diseases or disorders that might be a cause of or a contributor to chronic pelvic pain. These two approaches are not mutually exclusive, and in many patients effective therapy is best achieved by using both approaches. Treatment of chronic pain as well as treatment of four of the more common disorders associated with chronic pelvic pain (endometriosis, adhesions, irritable bowel syndrome, and interstitial cystitis) are discussed in this review.

In Brief

Chronic pelvic pain is a common and significant syndrome that may involve disorders of the reproductive, gastrointestinal, urological, musculoskeletal, and psychoneurological systems.

Author Information

From the Division of Gynecologic Specialties, University of Rochester School of Medicine and Dentistry, Rochester, New York.

We would like to thank the following individuals who, in addition to members of our Editorial Board, will serve as referees for this series: Dwight P. Cruikshank, MD, Ronald S. Gibbs, MD, Gary D. V. Hankins, MD, Philip B. Mead, MD, Kenneth L. Noller, MD, Catherine Y. Spong, MD, and Edward E. Wallach, MD.

We have invited select authorities to present background information on challenging clinical problems and practical information on diagnosis and treatment for use by practitioners.

Address reprint requests to: Fred M. Howard, MS, MD, University of Rochester School of Medicine and Dentistry, Department of Obstetrics and Gynecology, Division of Gynecologic Specialties, 601 Elmwood Avenue, Box 668, Rochester, NY 14642; E-mail: fred_howard@urmc.rochester.edu.

Received February 28, 2002. Received in revised form June 25, 2002. Accepted August 1, 2002.

© 2003 The American College of Obstetricians and Gynecologists