Chronic pelvic pain is more common than we think

It is difficult to ascertain the prevalence of a condition, such as chronic pelvic pain, which has few physical manifestations, but this has been accomplished successfully by Krina Zondervan and her colleagues (pages 1149–1155). The authors used the MediPlus UK Primary Care Database which holds information on over one million patients from 140 general practices in the United Kingdom. Over 24,000 women with chronic pelvic pain were identified, the definition of chronic pelvic pain being rigorous, excluding nearly all organic causes. The prevalence of chronic pelvic pain was 21.5 per thousand and the monthly incidence 1.58 per thousand women. The prevalence increased but the incidence decreased with increasing age, suggesting that chronic pelvic pain lasts longer in older women; and there were significant differences in prevalence across the regions of the United Kingdom. In an accompanying paper (pages 1156–1161) Zondervan and colleagues follow a cohort of women with chronic pelvic pain to determine the duration of their illness, the nature of their symptoms, the diagnostic labels given to their condition and the pattern of referral for specialist opinion and treatment. Nearly one-third of the women experienced symptoms for more than two years, the proportion increasing with age. The commonest symptoms were acyclical pelvic pain and gastrointestinal discomfort; and the commonest diagnostic labels were cystitis, irritable bowel syndrome and pelvic inflammatory disease. The rate of referral depended on the age of the woman, being common in women under the age of 60 but less usual in older women and in teenage girls. Chronic pelvic pain is therefore very common, and it is obvious that gynaecologists treat only very few of the total number of women who suffer from this condition. The pathology and psychology of chronic pelvic pain are poorly understood, and we must question the value of the diagnostic labels we apply to this condition; these may be more a manifestation of our training in physical medicine than a reflection of our understanding of the disorder. But in a sense assessment of the benefits of treatment is uncon-troversial, for it depends on the woman's perception of what is good and desirable; there is no other outcome that can be measured.