Pelvic pain in women.

Abstract

All women at some time experience pelvic pain associated with physiological events such as menstruation, ovulation, or sexual intercourse. Only a few women seek medical advice for such pain, yet it is the commonest reason for laparoscopy in Britain.1 In three quarters of cases no cause is found, but the reason for this is not clear. People's perception of pain varies, and women with unex? plained pelvic pain have often been diagnosed as suffering from psychogenic pain. Certainly, the incidence of anxiety and depres? sion is high in women with unexplained abdominal pain,2 3 but in some cases the pain may be due to genuine but unrecognised disease. For example, we and others have reported the consistent finding of pelvic varicosities in women who have often complained of a chronic dull ache in the pelvis (Adams J, et al, 24th British Congress of Obstetrics and Gynaecology, 1986).3 We have called this the pelvic pain syndrome. Many of these women have a history of serious disturbance to their normal emotional development in childhood,4 which may in some way underlie the subsequent development of varicosities. Whatever the cause, high levels of anxiety or depression certainly increase the severity of their pain. Thus it is clear that the diagnosis and management of pelvic pain are not as simple as is sometimes believed. Severe pain is not necessarily caused by obvious organic disease just as women who complain little of pain may have serious disease. It therefore pays to investigate the patient fully before making a diagnosis.