Evaluation and Management of Chronic Pelvic Pain in Women

Chronic pelvic pain is a challenging, often perplexing medical condition, affecting approximately 15% of women of reproductive age in the United States [1]. Chronic pelvic pain contributes significantly to health care costs, as it is the diagnosis that precedes up to 40% of diagnostic laparoscopies and 12% of hysterectomies [2]. With an estimated 20% of women with chronic pelvic pain seeking specialized medical care, chronic pelvic pain accounted for an estimated $2.9 billion in costs in 1999 [3]. While there is no universally accepted definition of chronic pelvic pain [4,5], the American College of Obstetricians and Gynecologists has proposed that chronic pelvic pain be defined as noncyclic pain lasting at least 6 months, localized to the anatomic pelvis and of sufficient severity to cause functional disability or the need for medical care [2]. The ambiguity about what constitutes chronic pelvic pain makes appropriate evaluation, diagnosis, and management challenging. The diagnostic process is further complicated because etiologies can stem from gynecologic, urologic, gastrointestinal, musculoskeletal, or psychoneurologic abnormalities [2,6,7]. Additionally, there is debate about the importance of making a conclusive diagnosis before beginning treatment [8], especially since diagnostic tests can be time-consuming, inconclusive, and expensive. The treatment of chronic pelvic pain may be medical, surgical, psychiatric, or multidisciplinary in approach [9].