Chronic pelvic pain in women – a review of the literature

Abstract

Chronic pelvic pain (CPP) can be a debilitating and sometimes life-changing condition. It affects both sexes, but is more common in women. The socioeconomic cost of CPP is huge and treatment requires a multidisciplinary approach. Treatment of CPP may be lengthy with disappointing results and the management of the condition is an ever-evolving field with some options still in their infancy. We have reviewed the literature on CPP, identified using various internet databases, focusing on the management of CPP in women over the last 15 years and examining the available evidence for the efficacy of the management options of CPP. A review of the relevant literature indicates that the causes of CPP in women may be both gynaecological and non-gynaecological. CPP may be a result of multiple factors and the treatment of this condition can be medical or surgical; other treatment modalities include psychotherapy, physiotherapy and lifestyle modification, and treatment may involve the use of more than one modality. Medical treatment includes the prolonged use of hormonal preparations for specific causes or the non-specific control of pain using analgesics whereas surgical management of CPP targets the specific tissues involved and may include the partial or complete excision of pathological tissues. Physical therapy was found to be helpful in managing symptoms of pelvic floor pain and abdominal myofascial pain and psychological therapy modifies symptoms in CPP, especially if a significant organic cause is present. Further randomized controlled studies are required to determine the efficacy of some of these treatment methods.