Chronic pelvic pain

Definition

• Chronic pelvic pain is persistent or cyclically recurring, disabling pain in the pelvis; depending on the definition, a duration of at least 3 to 6 months is required.
• Dysmenorrhoea, dyspareunia, dysuria and dyschezia may accompany it.

Occurrence & epidemiology

Epidemiology

• Prevalence estimates vary widely, roughly between 4 and 24% of women; the prevalence is similar to that of migraine, asthma or chronic back pain.
• Despite assessment, an estimated half of cases remain undiagnosed.

Aetiopathogenesis

Aetiology and pathogenesis

• Causes are grouped by organ system; gynaecological causes are mainly endometriosis, pelvic congestion syndrome, pelvic inflammatory disease, adenomyosis and hydrosalpinx, gastrointestinal ones include irritable bowel syndrome and inflammatory bowel disease.
• Common associated conditions are depression, anxiety, fibromyalgia and interstitial cystitis; there is also a strong association with previous physical or emotional trauma.
• It is a centralised pain with a lowered pain threshold, hyperalgesia and allodynia.

Clinical features

• In endometriosis, acute pain can become centralised and chronic over a period of 3 to 6 months.
• Numerous accompanying symptoms or precipitating factors may support the diagnosis.

Diagnosis

• The diagnosis is based largely on history and physical examination.
• Imaging and laboratory tests are often inconclusive but help to identify contributing conditions.

Keep learning in the app

Further reading (selection)

1. StatPearls: Chronic Pelvic Pain

Cross-references