Abstract
Chronic pelvic pain is defined as pain in the pelvis lasting for more than six months (some say three). The pain may be experienced in any of the structures of the pelvis, including the gynaecological organs; the lower urinary and gastrointestinal tract; and the vascular, neural and musculoskeletal systems. The pain can be continual, cyclical, provoked or unprovoked, and is frequently multifocal. A woman who complains of painful sex, for example, may also report vulvovaginal pain and dyspareunia; bladder frequency, urgency and suprapubic pain, as well as irritable bowel symptoms. Although an initiating event is sometimes described, such as an episode of severe “thrush” or cystitis, or following pelvic surgery or childbirth, this initial insult may be long forgotten and no longer relevant. Vulvodynia, endometriosis, bladder pain syndrome and irritable bowel syndrome are common causes of chronic pelvic pain in women but are often misdiagnosed and poorly managed.
Highlights
Chronic pelvic pain is defined as pain in the pelvis lasting for more than six months
Doctors and patients have a low threshold for snap diagnoses, such as recurrent vulvovaginal candidiasis in the case of vulvodynia with or without dyspareunia, and recurring urinary tract infection (UTI) or irritable bowel syndrome (IBS) with respect to low abdominal and pelvic pain
Good results in up to 75% of users have been reported after 25-35 sessions of transcutaneous electrical nerve stimulation (TENS), self-administered with a vaginal probe
Summary
Chronic pelvic pain is defined as pain in the pelvis lasting for more than six months (some say three). With these four domains in mind, the clinician can formulate an individualised approach which takes into account multiple factors in a particular patient An inflammatory trigger, such as infection, allergy or endometriosis, may be both an initiating and an aggravating factor, but pelvic floor muscle tension, initially secondary as a guarding reflex, may become the primary factor in perpetuating the pain. Pain results in loss of libido, sex-avoidance, emotions of guilt, low self-esteem and depression which can lead to relationship dysfunction and strain An approach in this patient, for example, while keeping the inflammatory trigger at bay with prophylaxis against recurrent vulvitis, a UTI or the suppression of endometriosis, requires pelvic floor rehabilitation. Psychosocial and sexual aspects may need to be addressed, as progress may be slow and requires coping strategies and partner participation to achieve resolution
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