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Chronic Pelvic Pain: An Integrated Approach to Diagnosis and Treatment

Gunter, Jennifer MD, FRCS(C), FACOG

Obstetrical & Gynecological Survey: September 2003 - Volume 58 - Issue 9 - pp 615-623

Chronic pelvic pain affects upward of 15% of women and is a frustrating condition for both patients and physicians. Chronic pelvic pain is not a disease, but a syndrome that results from a complex interaction between neurologic, musculoskeletal, and endocrine systems that is further influenced by behavioral and psychologic factors. Traditional approaches to this disorder have been surgical, although long-term success rates have been disappointing. Placebo response to surgery is common, and many conditions that contribute to the pain cannot be identified or treated with a surgical approach. Many patients will require a combination of both pharmacologic and nonpharmacologic treatments in addition to various types of invasive procedures. It is now recognized that many disorders contribute to the chronic pelvic pain symptom complex; thus, an integrated multidisciplinary approach to diagnosis and treatment is essential to achieve the greatest success.

Target Audience: Obstetricians & Gynecologists, Family Physicians

Learning Objectives: After completion of this article, the reader will be able to describe the pathophysiology of chronic pelvic pain, to outline the evaluation of a patient with chronic pelvic pain, and to explain the treatment options for patients with chronic pelvic pain.

Chronic pelvic pain (CPP), defined as pelvic pain of at least 6 months duration, is a complex and challenging problem that is a major cause of morbidity and disability for women. When pain is felt in the pelvic region, both patients and physicians most commonly ascribe it to an origin in the reproductive tract. Unfortunately, many women proceed to extirpative procedures only to be left with the same pain postoperatively. Population-based studies in the United States and United Kingdom have reported the prevalence of CPP among reproductive-aged women to be 14.7% and 24.0%, respectively (1,2). By extrapolating the data, more than 9 million reproductive-aged women in the United States would meet the criteria for chronic pelvic pain, with direct costs of more than $2.8 billion and indirect costs greater than $555 million (1). The pathogenesis of chronic pelvic pain is poorly understood, and, unfortunately, many patients who fail to respond to surgical intervention are erroneously labeled with a psychogenic cause of their pain.

Assistant Professor, Department of Obstetrics and Gynecology, The University of Colorado Health Sciences Center, Denver, Colorado

CHIEF EDITOR’S NOTE: This article is part of a series of continuing education activities in this Journal through which a total of 36 AMA/PRA category 1 credit hours can be earned in 2003. Instructions for how CME credits can be earned appear on the last page of the Table of Contents.

Reprint requests to: Jennifer Gunter, MD, Department of Obstetrics and Gynecology, The University of Colorado Health Sciences Center, 4200 East 9th Avenue, Denver, CO 80262. E-mail:

© 2003 Lippincott Williams & Wilkins, Inc.