Chronic pelvic pain is a syndrome of pain arising from one or more pelvic organs, and can include any one or all pelvic viscera or muscles.
A methodical, complete, criteria-based history is required to determine how many and which organ systems are involved and to uncover comorbid psychiatric conditions, particularly depression or a history of abuse.
The physical examination must be methodical and complete, searching for point tenderness in all individual pelvic muscles and organs, specifically including the vestibule, levator ani muscles, bladder, cervix and uterus, adnexa, and lower abdominal wall.
Diagnostic tests are determined by the organ systems generating pain and may include urinalysis with culture, pelvic ultrasound, cystoscopy with hydrodistension, and diagnostic laparoscopy.
Because chronic pain is sometimes a disorder of pain perception, minimal if any pathological change may be found.
Treatment is targeted at each organ system involved in pain production. Global pain in all organs or refusal of non-narcotic management may represent drug-seeking behaviour.
Complications are inherent to all treatments, which frequently include surgery.
Chronic pelvic pain is inconsistently defined, but the American College of Obstetricians and Gynecologists recommended definition is pain lasting for 6 months or more localised to the pelvis, the anterior abdominal wall at or below the umbilicus, the lumbosacral back, or the buttocks, that is of sufficient severity to cause functional disability or lead to medical care.
Patients typically present with at least two of several common pain-related diagnoses: interstitial cystitis, irritable bowel syndrome, fibromyalgia, levator ani syndrome (pelvic floor tension myalgia), endometriosis, adenomyosis, leiomyoma, or vulvodynia. Common comorbid conditions include depression, anxiety, and traumatic stress disorder.
History and exam
- presence of risk factors
- abdominal trigger points
- levator ani tenderness
- cervical motion tenderness
- uterine tenderness
- abdominal tenderness
- vestibular tenderness
- rectal tenderness
- adnexal tenderness
- bladder tenderness
- urethral tenderness
Obstetrics and Gynecology
Independence Park Medical Services
BWF has served as a consultant for Advance Medical and a Guidepoint Global Board Member for the International Pelvic Pain Society.
Dr Bradford W. Fenton would like to gratefully acknowledge the assistance of Dr Jennifer J. Schmitt in producing this topic. JJS declares that she has no competing interests.
Associate Professor and Chief
General Division of Obstetrics and Gynecology
University of Utah School of Medicine
Salt Lake City
HS has been reimbursed for attending and participating in conferences on pelvic varicosity pain syndrome by Cook Inc.
Obstetrics and Gynaecology
CS declares that he has no competing interests.
Consultant Obstetrician and Gynaecologist
Barnet and Chase Farm Hospitals NHS Trust
Chase Farm Hospital
DS-O declares that he has no competing interests.
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