Gynecologic and reproductive morbidity during adolescence and subsequent chronic pelvic pain in adulthood: a population-based matched cohort study

Shay M. Freger, Olga Bougie, Maya K. Djerboua, Maria P. Vélez, Mathew Leonardi
In: The Lancet Regional Health - Americas · 2026 · pp. 101641 · doi:10.1016/j.lana.2026.101641 · W7220688931
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In a population-based matched cohort study, adolescent healthcare encounters for gynecologic or reproductive morbidity were associated with a significantly higher hazard of incident chronic pelvic pain in adulthood.

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Abstract

Background Chronic pelvic pain (CPP) is often described as a multisystem pain condition, yet population-level evidence on adolescent antecedents is scarce. We examined whether healthcare encounters for gynecologic or reproductive morbidity during adolescence were associated with incident CPP in adulthood. Methods In this population-based matched cohort study in Ontario, Canada, we used linked administrative health data to identify individuals assigned female at birth who turned 18 years between Jan 1, 2008, and Jan 1, 2020. Exposed participants had at least one emergency department or inpatient encounter, or at least two outpatient encounters, for gynecologic or reproductive conditions between ages 10 and < 18 years. They were matched 1:2 to unexposed participants by birth year, neighborhood income quintile, and rurality. Follow-up began at the 18th birthday and continued until incident CPP, death, loss of health-insurance eligibility, or March 2025. Associations were estimated using cause-specific Cox models adjusted for adolescent comorbidity and healthcare utilization. Findings Among 466,560 matched individuals, 155,520 were exposed, and 311,040 were unexposed. Before adulthood, mental health diagnoses occurred in 71,557 (46.0%) exposed and 76,950 (24.7%) unexposed participants; non-pelvic chronic pain in 45,569 (29.3%) and 54,972 (17.7%); gastrointestinal morbidity in 91,688 (59.0%) and 96,858 (31.1%); and hospital admission in 28,880 (18.6%) and 22,418 (7.2%), respectively. Incident adult CPP occurred in 46,014 exposed participants (29.6%) and 50,447 unexposed participants (16.2%). After adjustment, exposure was associated with a higher hazard of adult CPP (hazard ratio 1.41, 95% confidence interval 1.39–1.43). Interpretation Healthcare encounters for gynecologic morbidity during adolescence identify a large population at increased risk of adult CPP. These findings support earlier recognition and integrated assessment of adolescent pelvic and menstrual symptoms before chronic pain trajectories become established. Funding Canadian Society for the Advancement of Gynecologic Excellence (CanSAGE).

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