9 - Chronic pelvic pain

Summary

Chronic pelvic pain (CPP) may profoundly affect women's ability to function normally in their various roles. Chronic pain may damage their ability to care for their children or maintain social networks, leading to relationship breakdown and loss of quality of life. Factors such as depression and sleep disturbance might reasonably be expected to affect the pain experience but it is increasingly apparent that other factors within the central nervous system will also modify the experience of chronic pain. The contributory factors in the genesis of CPP are gynaecological, bowel-related, bladder-related, musculoskeletal, neurological, and psychological. In women of reproductive age, pelvic pain alone is very rarely a presenting symptom of sinister pathology, but some red flag symptoms might warrant a more urgent approach. Diagnostic laparoscopy may be useful particularly if the woman is concerned about fertility. Additionally, simple assessment often from the patient history can identify therapeutic opportunities.