Chronic pelvic pain

Most women (and some men), at some time in their lives, experience pelvic pain. When the condition persists for longer than 3 months, it is called chronic pelvic pain (CPP). This is a poorly-understood condition that likely represents abnormal neurological function, either in the peripheral nervous system or central nervous system. Many different etiologies have been proposed for CPP, but a major problem is that virtually none of them have been validated. Commonly proposed etiologies include:

Women with symptoms of pain may want to see a gynecologist if problems don't go away after a few days, and workup should begin with a careful history and examination, followed by a pregnancy test. Some women may also need bloodwork or additional imaging studies, and a handful may also benefit from having surgical evaluation using small telescopes (laparoscopy). Many women will also benefit from a consultation with a physical therapist, a trial of anti-inflammatory medications, hormonal therapy, or even neurological agents.
 * endometriosis (very controversial)
 * infection or post-infectious neurological hypersensitivity
 * exaggerated bladder, bowel, or uterine pain sensitivity (also known as visceral pain)
 * ovarian cysts, uterine leiomyoma - often found in asymptomatic patients as well, however
 * less common emergencies: ovarian torsion - sudden loss of circulation to the ovary, appendicitis - infection of one part of the intestine, with right lower abdominal pain, ectopic pregnancy - where an early pregnancy grows outside of the uterus, and can cause sudden, heavy intra-abdominal bleeding
 * pelvic girdle pain (SPD or DSP)

This is a condition that although common, direly needs to be studied more closely.

Chronic Pelvic Pain in Female Adolescents
As girls enter gynecologic maturity, pelvic or abdominal pain becomes a frequent complaint.

Chronic pelvic pain (CPP) accounts for 10% of all visits to gynecologists. In addition, CPP is the reason for 20 - 30% of all laparoscopies in adults.

Etiology

 * Gynecologic Etiologies
 * Dysmenorrhea
 * Endometriosis
 * Muellerian abnormalities
 * Pelvic Inflammatory Disease
 * Ovarian Abnormalities


 * Abdominal Etiologies

Additional Resources

 * Milburn A, Reiter R, Rhomberg A: Multi-disciplinary approach to chronic pain. Obstet Gynecol Clin 1993;20:643 - 661.
 * Stovall DW: Endometriosis associated pelvic pain: Evidence for an association between the stage of disease and a history of chronic pelvic pain. Fertil Steril 1997;68:13 - 17.
 * Schroeder B, Sanfillippo JS: Chronic Pelvic Pain and Recurrent Abdominal Pain in Female Adolescents. Pediatr Clin North Am 1999;46:566 - 567.
 * Elisabeth Thibaud, Hyams JS: Clinical aspects of recurrent abdominal pain. Pediatric and Adolescent GynecologyPediatr Ann 2001;30:17–21.
 * Jantos M.: Understanding Chronic Pelvic Pain. Pelviperineology Vol. 26 N.2 June 2007 66-68