Chronic Pelvic Pain: Overview of Evaluation and Treatment

Abstract

The sensation of pain varies greatly among individuals, with one person’s nuisance being another individual’s agony.¹ Patients present to the gynecologist with pain that can be located anywhere from the diaphragm to the knees. Furthermore, this pain may be complicated by the fact that it is associated with nausea, vomiting, diarrhea, dizziness, palpitations, syncope, and migraine headache. The latter types of dysfunction may be associated with aberrant prostanoid and/or sex steroid production. Pelvic pain may come from bone, the neuromuscular system, nerve compression or irritation, the bowel, the bladder, connective tissue, the reproductive system, or the psyche.^2–4 The pain may be point specific or diffuse, it may be intermittent or continuous, cyclic or noncyclic, or related to activity and exercise, as well as diet. The patient who presents with chronic abdominopelvic pain may have a history of chronic disease, such as pelvic inflammatory disease, endometriosis, and has probably undergone multiple surgical procedures. Therefore, in the later stages, most abdominal pains have an iatrogenic underlying component that has been introduced into the situtation as a result of surgery.⁵⁶