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The source of chronic pelvic pain may be reproductive organ, urological, musculoskeletal - neurological, gastrointestinal,
or myofascial. A psychological component almost always is a factor whether as an antecedent event or presenting
as depression as result of the pain.
In a review of 500 patients treated between 1990 and 1996, who presented with chronic pelvic pain, 70% were found
to have reproductive organ disease, 8% musculoskeletal - neurological, 7% myofascial, 5% urologic, and 10% gastrointestinal.
Psychological issues were present in 80% of these patients, 25% of whom had antecedent events and the remainder
of whom were experiencing depression as result of the pain. Fifty six percent of the total patient population were
found to have endometriosis and 14% other gynecologic pathology. Thus 30-40% of patients who present with chronic
pelvic pain will be diagnosed by careful history and physical to have disease that is not of reproductive organ
source and appropriate studies and consultation will result in treatment of approximately 30% of patients with
chronic pelvic pain without resorting to laparoscopic surgery. 1
By using clinical judgment to properly diagnose the origin of chronic pelvic pain, 30% of patients will be found
to have non-gynecologic causes of pain which can primarily be treated medically. Of the remaining 70% of patients,
80% of these have endometriosis of whom ½ will respond to medical therapy with GnRH agonist to resolve their
pain. Surgical therapy is still requires in a large portion of patients with chronic pelvic pain, approximately
42% of patients requiring surgery for treatment of their pain syndrome. By reserving surgery for those in whom
medical therapy has failed, the practitioner will increase the success of surgery and also will provide better
care for the patients and have a more successful outcome overall in the treatment of this otherwise frustrating
disorder. By following this approach, the physician is able to avoid the historical 40% negative laparoscopies
associated with the study of patients with chronic pelvic pain. 2
References:
1. Carter JE: Chronic Pelvic Pain In Women. Presented at Endometriosis Symposium, ISGE Annual Meeting - April,
16, 1996, Chicago, IL
2. Howard, FM. The role of laparoscopy is chronic pelvic pain: promise and pitfalls. Obstet Gynecol
Surv. 1993;48:357-387.
