Chronic pelvic pain

This chapter reviews the pelvic anatomy, differential diagnosis, and management, including the role of multidisciplinary assessment and treatment of chronic pelvic pain (CPP). Chronic pelvic pain (CPP) is pelvic pain that has persisted for six months or more. The amount of pain is often greater than the degree of pathology. Dysmenorrhea or painful menses is the most common category of cyclic pelvic pain. It is a common disorder of the female reproductive tract and affects approximately 50 percent of menstruating women. Several mechanisms are likely to activate the thoracolumbar and pelvic afferents invoking dysmenorrhea. In primary dysmenorrhea, onset of pain generally occurs approximately one year following menarche when ovulatory cycles are established. The standard treatment for primary dysmenorrhea is prostaglandin synthetase inhibitors. Dosing requires around-the-clock administration at the onset of menses or, preferably, one to two days prior to onset of pain for the first few days of menses.