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Causes of chronic pelvic pain in women

INTRODUCTION

Chronic pelvic pain (CPP) refers to pain of at least six months' duration that occurs below the umbilicus and is severe enough to cause functional disability or require treatment. In the United States, this problem accounts for approximately 10 percent of all ambulatory referrals to a gynecologist and is a common indication for diagnostic and therapeutic surgery [1]. It is considered the principal indication for approximately 20 percent of hysterectomies performed for benign disease and at least 40 percent of gynecological laparoscopies [2,3].

The causes of CPP will be reviewed here. Evaluation and treatment of this disorder are discussed separately. (See "Evaluation of chronic pelvic pain in women" and "Treatment of chronic pelvic pain in women".)

PREVALENCE

The prevalence of CPP ranges from 4 to 16 percent, but only about one-third of women with CPP seek medical care [4-7]. Representative examples of surveys that have attempted to determine the prevalence of CPP in specific populations are described below:

  • A study of 635 women aged 20 to 50 years living in Seveso, Italy reported a prevalence of 4 percent for moderate to severe CPP [4].
  • A survey of patient records of 136 primary care practitioners in the United Kingdom also observed a 4 percent prevalence of CPP among 284,162 women aged 12 to 70 years [5]. The prevalence of CPP in this population was similar to that of migraine, back pain, and asthma.
  • A population-based study in New Zealand designed to investigate the prevalence of CPP in women between the ages of 18 and 50 years noted that 25 percent of the 1160 women surveyed reported CPP over a three- month interval [6].
  • In the United States, the Gallup organization performed a population-wide survey of women 18 to 50 years of age and found that of eligible women who agreed to participate, 15 percent reported they had experienced CPP within the past three months [7]. The prevalence of pain sufficiently severe to miss work was 4 percent, similar to the prevalence reported in the Italian and United Kingdom studies. Characteristics of women with CPP in this study are described in the table (table 1).

ETIOLOGY

Potential causes of CPP are listed in the table (table 2). The relative frequency of the various causes of CPP is significantly influenced by the local patient population, referral patterns, and specialty focus of the practice. In fact, one population-based study found that gastrointestinal and urologic problems were more common than gynecological conditions in women with CPP; gynecologic conditions accounted for approximately 20 percent of cases of CPP in this population [8].

                                     

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Literature review current through: May 2013. | This topic last updated: Apr 11, 2012.
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References
Top
  1. Reiter RC. A profile of women with chronic pelvic pain. Clin Obstet Gynecol 1990; 33:130.
  2. Farquhar CM, Steiner CA. Hysterectomy rates in the United States 1990-1997. Obstet Gynecol 2002; 99:229.
  3. Howard FM. The role of laparoscopy in chronic pelvic pain: promise and pitfalls. Obstet Gynecol Surv 1993; 48:357.
  4. Lippman SA, Warner M, Samuels S, et al. Uterine fibroids and gynecologic pain symptoms in a population-based study. Fertil Steril 2003; 80:1488.
  5. Zondervan KT, Yudkin PL, Vessey MP, et al. Prevalence and incidence of chronic pelvic pain in primary care: evidence from a national general practice database. Br J Obstet Gynaecol 1999; 106:1149.
  6. Grace VM, Zondervan KT. Chronic pelvic pain in New Zealand: prevalence, pain severity, diagnoses and use of the health services. Aust N Z J Public Health 2004; 28:369.
  7. Mathias SD, Kuppermann M, Liberman RF, et al. Chronic pelvic pain: prevalence, health-related quality of life, and economic correlates. Obstet Gynecol 1996; 87:321.
  8. Zondervan KT, Yudkin PL, Vessey MP, et al. Patterns of diagnosis and referral in women consulting for chronic pelvic pain in UK primary care. Br J Obstet Gynaecol 1999; 106:1156.
  9. Zondervan KT, Yudkin PL, Vessey MP, et al. Chronic pelvic pain in the community--symptoms, investigations, and diagnoses. Am J Obstet Gynecol 2001; 184:1149.
  10. Howard FM. The role of laparoscopy in the evaluation of chronic pelvic pain: pitfalls with a negative laparoscopy. J Am Assoc Gynecol Laparosc 1996; 4:85.
  11. Ness RB, Soper DE, Holley RL, et al. Effectiveness of inpatient and outpatient treatment strategies for women with pelvic inflammatory disease: results from the Pelvic Inflammatory Disease Evaluation and Clinical Health (PEACH) Randomized Trial. Am J Obstet Gynecol 2002; 186:929.
  12. Trautmann GM, Kip KE, Richter HE, et al. Do short-term markers of treatment efficacy predict long-term sequelae of pelvic inflammatory disease? Am J Obstet Gynecol 2008; 198:30.e1.
  13. Haggerty CL, Peipert JF, Weitzen S, et al. Predictors of chronic pelvic pain in an urban population of women with symptoms and signs of pelvic inflammatory disease. Sex Transm Dis 2005; 32:293.
  14. Practice Committee of the American Society for Reproductive Medicine, Society of Reproductive Surgeons. Pathogenesis, consequences, and control of peritoneal adhesions in gynecologic surgery. Fertil Steril 2007; 88:21.
  15. Howard FM, El-Minawi AM, Sanchez RA. Conscious pain mapping by laparoscopy in women with chronic pelvic pain. Obstet Gynecol 2000; 96:934.
  16. Beard RW, Reginald PW, Wadsworth J. Clinical features of women with chronic lower abdominal pain and pelvic congestion. Br J Obstet Gynaecol 1988; 95:153.
  17. Rozenblit AM, Ricci ZJ, Tuvia J, Amis ES Jr. Incompetent and dilated ovarian veins: a common CT finding in asymptomatic parous women. AJR Am J Roentgenol 2001; 176:119.
  18. Stanford EJ, Dell JR, Parsons CL. The emerging presence of interstitial cystitis in gynecologic patients with chronic pelvic pain. Urology 2007; 69:53.
  19. Aslam N, Harrison G, Khan K, Patwardhan S. Visceral hyperalgesia in chronic pelvic pain. BJOG 2009; 116:1551.
  20. Parsons CL. Diagnosing chronic pelvic pain of bladder origin. J Reprod Med 2004; 49:235.
  21. O'Leary MP, Sant GR, Fowler FJ Jr, et al. The interstitial cystitis symptom index and problem index. Urology 1997; 49:58.
  22. Lane TJ, Manu P, Matthews DA. Depression and somatization in the chronic fatigue syndrome. Am J Med 1991; 91:335.
  23. Williams RE, Hartmann KE, Sandler RS, et al. Recognition and treatment of irritable bowel syndrome among women with chronic pelvic pain. Am J Obstet Gynecol 2005; 192:761.
  24. American Academy of Pediatrics Subcommittee on Chronic Abdominal Pain. Chronic abdominal pain in children. Pediatrics 2005; 115:812.
  25. Porpora MG, Picarelli A, Prosperi Porta R, et al. Celiac disease as a cause of chronic pelvic pain, dysmenorrhea, and deep dyspareunia. Obstet Gynecol 2002; 99:937.
  26. Wolfe F, Smythe HA, Yunus MB, et al. The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis Rheum 1990; 33:160.
  27. Tu FF, Fitzgerald CM, Kuiken T, et al. Comparative measurement of pelvic floor pain sensitivity in chronic pelvic pain. Obstet Gynecol 2007; 110:1244.
  28. Loos MJ, Scheltinga MR, Mulders LG, Roumen RM. The Pfannenstiel incision as a source of chronic pain. Obstet Gynecol 2008; 111:839.
  29. Sharp HT. Myofascial pain syndrome of the abdominal wall for the busy clinician. Clin Obstet Gynecol 2003; 46:783.
  30. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Washington DC, American Psychiatric Association; 1994.
  31. Rapkin AJ, Kames LD, Darke LL, et al. History of physical and sexual abuse in women with chronic pelvic pain. Obstet Gynecol 1990; 76:92.
  32. Walling MK, Reiter RC, O'Hara MW, et al. Abuse history and chronic pain in women: I. Prevalences of sexual abuse and physical abuse. Obstet Gynecol 1994; 84:193.
  33. Meltzer-Brody S, Leserman J, Zolnoun D, et al. Trauma and posttraumatic stress disorder in women with chronic pelvic pain. Obstet Gynecol 2007; 109:902.
  34. Heim C, Newport DJ, Heit S, et al. Pituitary-adrenal and autonomic responses to stress in women after sexual and physical abuse in childhood. JAMA 2000; 284:592.
  35. Lorençatto C, Petta CA, Navarro MJ, et al. Depression in women with endometriosis with and without chronic pelvic pain. Acta Obstet Gynecol Scand 2006; 85:88.
  36. Blumer D, Heilbronn M. Chronic pain as a variant of depressive disease: the pain-prone disorder. J Nerv Ment Dis 1982; 170:381.
  37. Walker E, Katon W, Harrop-Griffiths J, et al. Relationship of chronic pelvic pain to psychiatric diagnoses and childhood sexual abuse. Am J Psychiatry 1988; 145:75.
  38. Randolph ME, Reddy DM. Sexual functioning in women with chronic pelvic pain: the impact of depression, support, and abuse. J Sex Res 2006; 43:38.
  39. Eisendrath SJ. Psychiatric aspects of chronic pain. Neurology 1995; 45:S26.
  40. Nolan TE, Metheny WP, Smith RP. Unrecognized association of sleep disorders and depression with chronic pelvic pain. South Med J 1992; 85:1181.