The Potential of Cesarean Section as a Causative Factor of Chronic Pelvic Pain.

Chronic pelvic pain (CPP) is a prevalent condition among women, particularly those of reproductive age, estimated at around 4%.1 In Brazil, the prevalence data are lacking, but it may be higher than 10%.2,3 The initial diagnosis is eminently clinical and, according to the International Association for the Study of Pain (IASP), it consists of chronic or persistent pain perceived in pelvis-related structures, often associated with emotional, sexual, behavioral, and negative cognitive consequences, aswell as symptoms suggestive of disorders in these systems. It includes both cyclic pain, such as dysmenorrhea, and the acyclic type. Although six months is the mostwidely used time criterion, it is arbitrary and, if the pain is not typically acute and central sensitization mechanisms are well documented (especially hyperalgesia), it can be considered chronic, regardless of time of symptom onset. Among the several risk factors attributed to CPP,4 we highlight the history of prior abdominal surgery, particularly low transverse incision of the abdominal wall (Pfannenstiel), commonly used in cesarean sections (CS) and other gynecological surgeries.5 Considering that CS is the most frequently performed abdominal surgery in the world6 and the fact that CS rates in Brazil are very high,7 it is known that many CPP cases can be attributed to CS.8 In clinical practice, many professionals, especially gynecologists and obstetricians, attribute the development of postoperative adhesions as the cause of pain. Moreover, they underestimate the diagnosis of pain originating in the abdominal wall,9 which is a confirmed cause of CPP, of simple treatment and a good response rate, preventing the need for surgical approach to clarify the diagnosis.