Initial Evaluation of Chronic Pelvic Pain

Chronic pelvic pain (CPP) has been traditionally defined by the duration of symptoms (usually 6 months or more). Among the elements that may contribute to CPP are (1) untreated or insufficiently treated organic disease; (2) physiologic responses to disease within the reproductive tract (e.g., uterine contractions in women with endometriosis); (3) pain signals from adjacent visceral systems (e.g., bladder and/or bowel irritability); (4) musculoskeletal sensing of pain from the back, abdominal wall, pelvic floor, and hip; and (5) psychological and emotional factors that may precede the illness or develop during its course. Thus, the clinician must evaluate both the evident pathology and other potential contributing factors; most evaluations can and should be done under the leadership of the gynecologist. Obtaining the patient’s history, performing a thorough physical examination, and ordering the correct diagnostic tests are all key to proper evaluation and treatment of CPP. History The clinician should question the patient thoroughly about her pain — its quality, intensity, and location; whether it radiates or is referred; its relation to activities, to stress, and to function of surrounding organ systems; and its evolution over time. CPP is rarely due to a single process, and it’s important to pay attention to components that gradually contribute to the initial pathology. For …