Causes of chronic pelvic pain in women
- Fred Howard, MD
Fred Howard, MD
- Professor of Obstetrics and Gynecology
- University of Rochester Medical Center
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.
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- Gynecologic etiologies
- - Endometriosis
- - Pelvic inflammatory disease
- - Adhesions
- - Pelvic congestion syndrome
- - Adenomyosis
- - Ovarian cancer
- - Ovarian remnant and residual ovary syndrome
- - Leiomyoma
- - Dysmenorrhea
- - Other
- Urinary tract
- - Interstitial cystitis/painful bladder syndrome
- - Other
- Gastrointestinal tract
- - Irritable bowel syndrome
- - Inflammatory bowel disease
- - Diverticular colitis
- - Colon cancer
- - Chronic intestinal pseudo-obstruction
- - Chronic constipation
- - Celiac disease
- Musculoskeletal system
- - Fibromyalgia
- - Coccydynia, piriformis/levator ani syndrome, pelvic floor tension myalgia
- - Posture
- - Chronic abdominal wall pain
- - Osteitis pubis
- Mental health issues
- - Somatization
- - Opiate dependency
- - Physical and sexual abuse
- - Depression
- - Sleep disorders
- Abdominal pain
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS