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 . 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".)
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 .
- 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 . 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 .
- 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 . 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).
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 .