Evaluation 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. This problem accounts for approximately 10 percent of all ambulatory referrals to a gynecologist and is a common indication for diagnostic and therapeutic surgery . In fact, CPP is considered the principal indication for approximately 20 percent of all hysterectomies performed for benign disease and at least 40 percent of all gynecological laparoscopies performed annually in the United States [2,3].
Women with chronic pelvic pain (CPP) are often disappointed with the quality of their medical consultations. A survey of women with CPP attending a gynecology clinic found that they want their clinician to: (1) provide personalized care; (2) be empathic and take their symptoms seriously; (3) provide an explanation as to the cause of their pain syndrome; and (4) be reassuring . A complete history, physical examination, and counseling can take 45 to 90 minutes in women with CPP. Given the intense time commitment required, the provider may need to schedule more than one visit to complete the initial clinical evaluation and counsel the patient.
The six major sources that contribute to pelvic pain should be considered in evaluating women with CPP (table 1):
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- Pelvic pain assessment form
- Pain history
- Pain map
- PHYSICAL EXAMINATION
- PSYCHOLOGICAL ASSESSMENT
- FINDINGS SUGGESTIVE OF SPECIFIC DISORDERS
- Abnormalities of the uterosacral ligament, cervical displacement
- Enlarged or irregular uterus
- Uterine, adnexal, or cervical motion tenderness
- Burning, paresthesias, dysesthesias
- Adnexal mass
- Diffuse tenderness
- Suburethral or suprapubic pain
- Tenderness and contraction of pelvic muscles
- Abdominal pain
- Vulvar and vestibular pain
- ADDITIONAL DIAGNOSTIC EVALUATION
- Laparoscopic surgery
- - Laparoscopic pain mapping
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS