Chronic pelvic pain in women

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 exam 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 pathologic change may be found.

Treatment is targeted at each organ system involved in pain production.

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 symptoms perceived to originate from pelvic organs/structures typically lasting more than 6 months. It is often associated with negative cognitive, behavioral, sexual and emotional consequences as well as with symptoms suggestive of lower urinary tract, sexual, bowel, pelvic floor, myofascial, or gynecological dysfunction".[1]American College of Obstetricians and Gynecologists' Committee on Practice Bulletins-Gynecology. ACOG Practice bulletin no. 218: chronic pelvic pain. Obstet Gynecol. 2020 Mar;135(3):e98-109. http://www.ncbi.nlm.nih.gov/pubmed/32080051?tool=bestpractice.com ​​​

Patients typically present with one or more 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.

This topic focuses on chronic pelvic pain in women. In men, chronic pelvic pain is sometimes called chronic prostatitis. See Primary prostate pain syndrome.