Women in pain : the course and diagnostics of chronic pelvic pain

The main subject of this thesis is pelvic pain in women in secondary and/or tertiary medical care. Studies aim to examine: \n 1.\tThe clinical course of acute abdominal pain and risks of pain persistence. \n 2.\tThe clinical course of chronic pelvic pain (CPP) and predictors of recovery. \n 3.\tThe moderating and /or mediating factors of sexual functioning. \n 4.\tThe reliability of videotaped compared to real-time laparoscopic findings.\n Results show that pain persisted in 30% of women after an acute episode of abdominal pain. A low education level and an abuse history at a younger age were risks for chronicity. Recovery from pain was observed in 20% to 25% of women with CPP. Only a decrease in catastrophizing pain was associated with an improvement in pain and adjustment. \n Women with CPP reported more sexual problems than pain free controls. Anxiety and depression moderated sexual problems, while sexual abuse was a non-specific predictor. \n Finally, the evaluations of videotaped laparoscopies to score endometriosis were reliable, apart from ovarian lesions. In case of adhesions such evaluations were inconsistent.\n Main conclusion: CPP in women has to be considered as a chronic pain condition in general. A model to assess women with CPP and facilitate pain management is suggested.