Chronic pelvic pain

Pelvic pain is a common Gynecological complaint, reported by about 1 in 4 women attending Gynecology clinics. It often leads to a poor quality of life if left untreated. Patients need a systemic evaluation to make a specific diagnosis and offer appropriate treatment strategies.

Patients will commonly present with cyclical pain, often associated with painful periods. Some will experience painful sexual intercourse, and there may be associated heavy periods as well. In some cases, there are also urinary and bowel symptoms. Simple pain killers do not provide adequate pain relief.

Due to the debilitating nature of chronic pelvic pain, sufferers often lead a poor quality of life. A thorough evaluation is often required to look for the cause and offer specific treatment options. In rare cases, there may be a serious disease process that would benefit from early diagnosis and treatment..

Common causes include: pelvic inflammatory disease (from previous sexual infections), endometriosis, adenomyosis, and pelvic adhesions (from previous surgery or infection). Some patients may have a rare condition called pelvic vascular congestion syndrome, whereas in others, there is no Gynecological cause for the pain. In such patients, the pain may be from other organs like the urinary tract or intestinal causes. Not uncommonly, there may be no apparent physical cause of the pain, and this is usually frustrating to patients.

When women present with pelvic pain, efforts must be directed at finding a specific cause. A thorough Gynecological clinical assessment is required to guide justification for subsequent tests. Initial tests include screening for infections and ultrasound imaging of the pelvis. Further imaging may be required with CT scan or MRI (Magnetic Resonance Imaging). Still in some patients, a cause will not be apparent and they will need a diagnostic laparoscopy. This is a surgical procedure using a telescope to directly visualise the pelvic organs. It is the only way to diagnose some causes like endometriosis which may be microscopic.

Treatment must be directed to the specific cause identified. It is important to realise that what may appear as disease on investigations may not be the cause of the pain. Additionally, no specific disease process will be evident following extensive investigations in some patients. Treatment strategies may often include a team of professionals (Gynecologists, Pain Specialists etc).

Treatment options include pain killers and hormone treatments, which can be used singly or in combination. In some, surgery will be required for example in cases of severe endometriosis. In extreme cases, some patients will only be cured after surgical removal of their pelvic organs. This is referred to as pelvic clearance and includes removal of the uterus (hysterectomy), and removal of the ovaries. If this is done in young women, they often require hormone replacement to negate effects of premature menopause

When seeking treatment, please make sure you completely understand the cause of your pelvic pain.If anything is unclear, ask questions and if in doubt seek a second opinion.Principles to guide decision making include:
• You do not always need any intervention
• Doing nothing is always an option
• Conservative measures should always be considered in appropriate cases
• Surgical options are rarely the first-line options as they are associated with more complications, and are more expensive

Long-term implications of chronic pelvic pain depend on the specific cause, and the treatment required. Your Gynecologist will be able to explain any long-term follow-up that may be required.