Abstract
Chronic pelvic pain (CPP) in women is a common disorder, affecting as many as 15% of adult women, and often provides both a diagnostic and therapeutic challenge. Pain in CPP may originate directly from pelvic organs, or maybe referred from more distant tissue sites. A comprehensive medical history and physical examination should include special attention to gynecological, urological, gastrointestinal, psychiatric, myofascial, and neuromuscular systems. The effective management of CPP may involve comprehensive evaluations by specialists, psychologists, and multiple office visits. Physicians should address CPP as a chronic disease. Combining lifestyle modification with other traditional treatments produces better outcomes. Laboratory tests, transvaginal ultrasound, and laparoscopy may identify serious disease or provide significant reassurance to patient. Specific surgical procedures for various conditions and pain relief measures are beneficial in selected patients. A sensitive physician who is willing to spend adequate time and coordinate care with specialists can markedly diminish the suffering of these patients.
Similar content being viewed by others
References
Howard FM. The role of laparoscopy in the chronic pelvic pain patient. Clinical Obstetrics and Gynecology 2003;46(4):749–766.
Zondervan KT, Yudkin PL, Vessey MP, Jenkinson CP, Dawes MG, Barlow DH, Kennedy SH. The community prevalence of chronic pelvic pain in women and associated illness behaviour. Br J Gen Pract 2001;51 (468):541–7.
Moore J, Kennedy S. Causes of chronic pelvic pain. Baillie re's Clinical Obstetrics and Gynaecology 2000;14(3):389–402.
Howard F. Acog Practice Bulletin No. 51 Chronic Pelvic Pain 589 2004; 103(3).
Mathias SD, Kuppermann M, Liberman RF, Lipschutz RC, Steege JF. Chronic pelvic pain: prevalence health-related quality of life, and economic correlates. Obstet Gynecol 1996;87(3):321–7.
Zondervan KT, Yudkin PL; Vessey MP; Dawes MG; Barlow DH; Kennedy SH. Patterns of diagnosis and referral in women consulting for chronic pelvic pain in UK primary care. Br J Obstet Gynaecol 1999; 106(11):1156–1161.
zondervan KT, Yudkin PL, Vessey MP, et al. Chronic pelvic pain in the community—symptoms, investigations, and diagnoses. Am J Obstet Gynecol 2001; 184(6):1149–1155.
Jamieson DJ, Steege JF. The prevalence of dysmenorrhea, dyspareunia, pelvic pain, and irritable bowel syndrome in primary care practices. Obstet Gynecol 1996;87(1):55–58.
Howard FM. The role of laparoscopy in chronic pelvic pain: promise and pitfalls. Obstet Gynecol Surv 1993;48:357–387.
Rosenthal RH. Psychology of chronic pelvic pain. Obstet Gynecol Clin North Am 1993;20:627.
Gunter J. Chronic pelvic pain: An integrated approach to diagnosis and treatment. Obstetrical & Gynecological Survey 2003; 58(9):615–623.
Zondervan KT, Yudkin PL, Vessey MP, Dawes MG, Barlow DH, Kennedy SH. Prevalence and incidence in primary care of chronic pelvic pain in women: evidence from a national general practice database. Br J Obstet Gynaecol 1999;106:1149–1155
Peters AA, van Dorst E, Jellis B, van Zuuren E, Hermans J, Trimbos JB. A randomized clinical trial to compare two different approaches in women with chronic pelvic pain. Obstet Gynecol 1991; 77(5):740–744
Walling MK, Reiter RC, O'Hara MW, Milburn AK, Lilly G, Vincent SD. Abuse history and chronic pain in women: I. Prevalences of sexual abuse and physical abuse. Obstet Gynecol 1994; 84(2):193–199.
Roseff SJ, Murphy AA. Loparoscopy in the diagnosis and therapy of chronic pelvic pain. Clin Obstet Gynecol 1990;33:137.
Carter JE. Combined hysteroscopic and laparoscopic findings in patients with chronic pelvic pain. J Am Assoc Gynecol Laparosc 1994:2(1):43–47.
Ripps BA, Martin DC. Focal pelvic tenderness, pelvic pain and dysmenorrhea in endometriosis. J Reprod Med 1991;36:470–472.
Lampe A, Doering S, Rumpold G, et al. Chronic pain syndromes and their relation to childhood abuse and stressful life events. J Psychosom Res 2003;54(4):361–367.
Ling FW. Randomized controlled trial of depot leuprolide in patients with chronic pelvic pain and clinically suspected endometriosis. Pelvic Pain Study Group. Obstet Gynecol 1999;93(1):51–58.
Koninckx PR, Lesaffre E, Meuleman C, et al. Suggestive evidence that pelvic endometriosis is a progressive disease whereas deeply infiltrating endometriosis is associated with pelvic pain. Fertil Steril 1991;55:759–765.
Fauconnier A, Chapron C, Dubuisson JB, Vieira M, Dousset B, Breart G. Relation between pain symptoms and the anatomic, location of deep infiltrating endometriosis. Fertil Steril 2002;78(4):719–726.
Sutton CJ, Pooley AS, Ewen SP, Haines P. Follow-up report on a randomized controlled trial of laser laparoscopy in the treatment of pelvic pain associated with minimal to moderate endometriosis. Fertil Steril 1997;68(6):1070–1074.
Husby GK, Haugen RS, Moen MH. Diagnostic delay in women with pain and endometriosis. Acta Obstet Gynecol Scand 2003; 82(7): 649–653.
Witz CA. Current concepts in the pathogenesis of endometriosis. Clin Obstet Gynecol 1999;42:566–585.
Eskenazi B, Warner M, Bonsignore L, Olive D, Samuels S, Vercellini P. Validation study of nonsurgical diagnosis of endometriosis. Fertil Steril 2001;76(5):929–935.
Rein DB, Kassler WJ, Irwin KL, Rabiee L Direct medical costs of pelvic inflammatory disease and its sequelae: decreasing, but still substantial. Obstet Gynecol 2000;95:397–402.
Ness RB, Soper DE, Holley RL, et al. Effectiveness of inpatient and outpatient treatment strategies for women with pelvic inflammatory disease: results from the Pelvic Inflammatory Disease Evaluation and Clinical Health (PEACH) Randomized Trial. Am J Obstet Gynecol 2002;186:929–937.
Westrom L. Sexually transmitted diseases and infertility. Sex Transm Dis 1994;21(Suppl):S32-S37.
Westrom L, Joesoef MJ, Reynolds G, Hagdu A, Thompson SE. Pelvic inflammatory disease and fertility: a cohort study of 1844 women with laparoscopically verified disease and 657 control women with normal laparoscopic results. Sex Transm Dis 1992;19:185–192.
Buchan H, Vessey M, Goldacre M, Fairweather J. Morbidity following pelvic inflammatory disease. Br J Obstet Gynecol 1993;100(6): 558–562.
Ness RB, Soper DE, Holley RL, Peipert J, et al. Effectiveness of inpatient and outpatient treatment strategies for women with pelvic inflammatory disease: results from the pelvic inflammatory disease evaluation and clinical health (PEACH) randomized trial. Am J Obstet Gynecol 2002;186:929–937.
Ness RB, Randall H, Richter HE, et al. Condom use and the risk of recurrent pelvic inflammatory disease, chronic pelvic pain, or infertility following an episode of pelvic inflammatory disease. Am J Public Health 2004;94(8):1327–1329.
Beard RW, Reginald PW, Wadsworth J. Clinical features of women with chronic lower abdominal pain and pelvic congestion. Br J Obstet Gynecol 1988;95(2):153–161.
Burkman RT. Chronic pelvic pain of bladder origin: epidemiology, pathogenesis and quality of life. J Reprod Med 2004;49(3 Suppl): 225–229.
Wesselmann U. Interstitial, cystitis: a chronic visceral pain syndrome. Urology 2001; 6(suppl 1):32–39.
van Ophoven A, Pokupic S, Heinecke A, Hertle L. A prospective, randomized, placebo controlled, double-blind study of amitriptyline for the treatment of interstitial cystitis. J Urol 2004;172(2):533–536.
Slocumb JC. Chronic somatic, myofascial, and neurogenic abdominal pelvic pain. Clin Obstet Gynecol 1990;33(1):145–153.
Prendergast SA, Weiss JM. Screening for musculoskeletal causes of pelvic pain. Clin Obstet Gynecol 2003;46(4):773–782.
van Os-Bossagh P, Pols T, Hop WC, Nelemans T, Erdmann W, Drogendijk AC, Bohnen AM. Questionnaire as diagnostic tool in chronic pelvic pain (CPP): a pilot study. Eur J Obstet Gynecol Reprod Biol 2002;103(2):173–178.
http://www.pelvicpain.org/pdf/FRM_Pain_Questionnaire.pdf.
Lampe A, Solder E, Ennemoser A, Schubert C, Rumpold G, Sollner W. Chronic pelvic pain and previous sexual abuse. Obstet Gynecol 2000;96(6):929–933.
Weiss JM. Pelvic floor, myofascial trigger points: manual therapy for interstitial cystitis and the urgency-frequency syndrome. J Urol 2001;166(6):2226–2231.
Bazot M. Fast breath-hold T2-weighted MR imaging reduces interobserver variability in the diagnosis of adenomyosis. AJR Am J Roentgenol 2003;180(5):1291–1296.
Elcombe S, Gath D, Day A. The psychological effects of laparoscopy on women with chronic pelvic pain. Psychol Med 1997; 27(5):1041–1050.
Peters AA, van Dorst E, Jellis B, van Zuuren E, Hermans J, Trimbos JB. A randomized clinical trial to compare two different approaches in women with chronic pelvic pain. Obstet Gynecol 1991;77(5):740–744.
Blumer D, Heilbronn M. Chronic pain as a variant of depressive disease: the pain-prone disorder. J Nerv Ment Dis 1982;170:381.
Walker E, Katon W, Harrop-Griffiths J, et al. Relationship of chronic pelvic pain to psychiatric diagnoses and childhood sexual abuse. Am J Psychiatry 1988;145:75.
Engel CC, Jr., Walker EA, Engel AL, Bullis J Armstrong A. A randomized, double-blind crossover trial of sertraline in women with chronic pelvic pain. J Psychosom Res 1998;2:203–207.
Vercellini P, Trespidi L, Colombo A, Vendola N, Marchini M, Crosignani PG. A gonadotrophin-releasing hormone agonist versus a low-dose oral contraceptive for pelvic pain associated with endometriosis. Fertil Steril 1993;60:75–79.
Ling FW. Randomized controlled trial of depot leuprolide in patients with chronic pelvic pain and clinically suspected endometriosis. Pelvic Pain Study Group. Obstet Gynecol 1999;93(1):51–58.
Steege JF, Stout AL. Resolution of chronic pelvic pain after laparoscopic lysis of adhesions. Am J Obstet Gynecol 1991;165:278–281.
Malik E, Berg C, Meyhofer-Malik A, Haider S, Rossmanith WG. Subjective evaluation of the therapeutic value of laparoscopic adhesiolysis: a retrospective analysis. Surg Endosc 2000; 14(1):79–81.
Peters AA, Trimbos-Kemper GC, Admiraal C, Trimbos JB, Hermans J. A randomized clinical trial on the benefit of adhesiolysis in patients with intraperitoneal adhesions and chronic pelvic pain. Br J Obstet Gynaecol 1992;99(1):59–62.
Stovall TG, Ling FW, Crawford DA. Hysterectomy for chronic pelvic pain of presumed uterine etiology. Obstet Gynecol 1990;75(4):676–679.
Lee RB, Stone K, Magelssen D, Belts RP, Benson WL. Presacral neurectomy for chronic pelvic pain. Obstet Gynecol 1986;68:517–521.
Chen FP, Soong YK. The efficacy and complications laparoscopic presacral neurectomy in pelvic pain. Obstet Gynecol 1997; 90:974–977
Zullo F, Palomba S, Zupi E, Russo T, Morelli M, Cappiello F Mastrantonio P. Effectiveness of presacral neurectomy in women with severe dysmenorrhea caused by endometriosis who were treated with laparoscopic conservative surgery: a 1-year prospective randomized double-blind controlled trial. Am J Obstet Gynecol 2003;189(1):5–10.
Chen FP, Chang SD, Chu KK, et al. Comparison of laparoscopic presacral neurectomy and laparoscopic uterine nerve ablation for primary dysmenorrhea. J Reprod Med 1996;41:463–466.
Everaert K, De Ridder D, Baert L, Oosterlinck W, Wyndaele JJ. Patient satisfaction and complications following sacral nerve stimulation for urinary retention, urge incontinence and perineal pain: a multicenter evaluation. Int Urogynecol J Pelvic Floor Dysfunct 2000;11(4):231–235.
Brown CS, Ling FW, Wan JY, Pilla AA. Efficacy of static magnetic field therapy in chronic pelvic pain: a double-blind pilot study. Am J Obstet Gynecol 2002;187(6):1581–1587.
Ruder R. Chronic pelvic pain. Am Fam Physician 1996;54(7): 2223–2232.
Reiter, RC. Evidence-based management of chronic pelvic pain. Clin Obstet Gynecol 1998;41(2):422–435.
Author information
Authors and Affiliations
Corresponding author
Additional information
The authors have stated that they do not have a significant financial interest or other relationship with any product manufacturer or provider of services discussed in this article. The authors also do not discuss the use of off-label products, which includes unlabeled, unapproved, or investigative products or devices.
About this article
Cite this article
Samraj, G.P.N., Kuritzky, L. & Curry, R.W. Chronic pelvic pain in women Evaluation and management in primary care . Compr Ther 31, 28–39 (2005). https://doi.org/10.1385/COMP:31:1:028
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1385/COMP:31:1:028