Evaluating chronic pelvic pain. A consensus recommendation. Pelvic Pain Expert Working Group.
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A consensus recommendation outlines a comprehensive approach to chronic pelvic pain evaluation in women, starting with history and physical exam, followed by empiric therapy if needed, and considering endometriosis/adenomyosis if symptoms persist.
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Abstract
OBJECTIVE: To identify a comprehensive approach to evaluating women with chronic pelvic pain based on findings in the literature. STUDY DESIGN: A working group of gynecologist pelvic pain specialists was convened to consider principles on which consensus could be reached and to identify areas in which consensus is not yet possible. RESULTS: Chronic pelvic pain affects 15% of American women. The diagnostic and therapeutic approach to the complaint may be influenced inordinately by the specialty of the practitioner to whom the woman presents. A comprehensive approach to the complaint requires recognition of the multiple organ systems that may be involved. Evaluation of the woman with chronic pelvic pain begins with a comprehensive history and physical examination, followed by selected laboratory and imaging studies. For those women in whom the evaluation does not yield a likely cause of the complaint, the empiric use of nonsteroidal antiinflammatory agents, oral contraceptives, and perhaps antibiotics or antispasmodics is indicated. Women who fail to respond to empiric therapy should be considered highly likely to have endometriosis or adenomyosis. Further diagnostic (laparoscopy) or therapeutic (gonadotropin-releasing hormone agonist) interventions should be directed toward the high likelihood of endometriosis or adenomyosis. CONCLUSION: A comprehensive approach to chronic pelvic pain includes consideration of multiple organ systems, with empiric therapy appropriate after a thorough history and physical examination, to further delineate the pain problem.
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Cited by (15)
- Chronic pelvic pain syndrome: Highlighting medicinal plants toward biomolecules discovery for upcoming drugs formulation 2019
- Surgical interventions for chronic pelvic pain 2016
- Chronischer Unterbauchschmerz der Frau 2014
- Endometriosis-associated pain syndrome: a nurse-led approach 2013
- Entwicklung und Evaluation einer Online-Kasuistik in der Psychosomatischen Gynäkologie und Geburtshilfe 2011
- Chronic pelvic pain in women: etiology, pathogenesis and diagnostic approach 2009
- Chronic pelvic pain: Cause, diagnosis and therapy from a gynaecologist's and an endoscopist's point of view 2009
- Medical, surgical and alternative treatments for chronic pelvic pain in women: a descriptive review 2009
- Using integrative therapies to treat women with chronic pelvic pain. 2007
- An osteopathic approach to treating women with chronic pelvic pain. 2005
- Chronic pelvic pain: a practical approach 2005
- The role of laparoscopy in the diagnosis and treatment of conditions associated with chronic pelvic pain 2004
- Pelvic Pain Scores in Women without Pelvic Pathology 2002
- Chronische Unterbauch- schmerzen "chronic pelvic pain syndrome" Ein multifaktorielles Krankheitsbild mit Indikation zur interdisziplinären Behandlung 2001
- Gynecologic presentation of interstitial cystitis as detected by intravesical potassium sensitivity 2001
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