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Treatment of chronic pelvic pain in women

Robert L Barbieri, MD
Section Editor
Howard T Sharp, MD
Deputy Editor
Kristen Eckler, MD, FACOG


Success in treating women with chronic pelvic pain (CPP) is greatly facilitated by earning their trust and confidence. This is best accomplished by performing a thorough evaluation, and by listening to them, validating that their pain is "real," offering explanations and reassurance, and making a commitment to try to help [1]. Most patients are able to understand that there are no "magic bullets" or instant cures and are satisfied with the knowledge that their physicians will make an honest effort to help them in a gradual and stepwise fashion.


Usually the history and physical examination suggest one or more diagnoses or disorders ("pain generators") that seem to cause or exacerbate CPP (table 1). (See "Causes of chronic pelvic pain in women" and "Evaluation of chronic pelvic pain in women".)

To decide on the best therapeutic plan for an individual patient, the physician and patient should have a thorough discussion of her preferences and values regarding testing, medical versus surgical treatment, and childbearing plans. For many patients, the optimal approach involves a combination of treatments.

Empiric trial of therapy based on diagnostic probabilities — One approach to managing women with CPP is to prescribe sequential drug treatments for disorders that are the most likely causes of the patient's CPP. As an example, endometriosis is the most common gynecological cause of CPP. If endometriosis seems a likely diagnosis based upon the history and physical examination, then a medical therapy for endometriosis is given for a trial period (see 'Endometriosis' below). If this is not successful, then a trial of another medical therapy is initiated. If one of these treatments relieves the pelvic pain, then the likelihood that endometriosis is the cause of CPP increases. However, it is important to note that improvement in symptoms is not absolute confirmation of a diagnosis since treatment effects are often not specific. As an example, hormonal treatment of endometriosis may also improve pelvic congestion syndrome, irritable bowel syndrome, or interstitial cystitis/painful bladder syndrome [2-4].

Intensive diagnostic evaluation followed by targeted therapy — A different approach is to use intensive diagnostic testing in an attempt to identify the specific cause of the patient's CPP, if possible, before starting specific therapy. Although therapy targeted specifically to the patient's diagnosis might appear ideal, arriving at a diagnosis may involve costly laboratory and imaging tests, and often requires exploratory surgery.

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Literature review current through: Nov 2017. | This topic last updated: Aug 24, 2017.
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