Chronic Pelvic Pain

Introduction

• Description: Chronic pelvic pain has been defined as noncyclic pain of 6 or more months’ duration that localizes to the anatomic pelvis, anterior abdominal wall at or below the umbilicus, lumbosacral back, or buttocks and is of sufficient severity to cause functional disability or lead to medical care. It is often associated with negative cognitive, behavioral, sexual, and emotional consequences. Chronic pelvic pain can be a vexing problem for the patient and physician, and many think the pain itself becomes the disease.

• Prevalence : 15% of women. In the United States: $3 billion annual economic cost; 12%–20% of hysterectomies and up to 40% of gynecologic laparoscopies are performed for pelvic pain; 10% of referrals to gynecologists are for pelvic pain.

• Predominant Age : 15–50 years; peak during 26–30 years.

• Genetics : Chronic pelvic pain disproportionately affects women. In one study, non-Hispanic Blacks had a higher incidence of pelvic pain.

Etiology And Pathogenesis

• Causes: Frequently unknown. There is growing evidence of central sensitization in perpetuating chronic pain syndromes.

• Risk Factors: Childhood physical or sexual abuse. A history of abuse, mental illness, lack of social support, social stressors, and relationship discord increase the risk of pelvic pain and dyspareunia.

Signs And Symptoms

• General: Nonspecific, diffuse lower abdominal, pelvic, or low back pain persisting for more than 6 months. Incomplete relief by most previous treatments.

Diagnostic Approach