Evaluation of Female Pelvic Pain

Jessica Chandler, Elena Wagner, Kristin Riley
In: Seminars in Reproductive Medicine · 2018 · vol. 36(02) , pp. 099–106 · doi:10.1055/s-0038-1676084 · PMID:30566975 · W2904762033
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⚙ AI-generated summary by claude@2026-06, 2026-06-09 ⓘ

This review outlines the evaluation of chronic female pelvic pain by emphasizing the importance of patient-physician relationships, in-depth history, targeted physical exams, and judicious use of imaging and laboratory tests.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-23 · read from full text ⓘ

This paper reviews how to evaluate chronic female pelvic pain, defined as pelvic pain lasting more than six months with sufficient severity to cause functional disability or require treatment, emphasizing that chronic pain often has multiple contributing factors. The authors describe that establishing a trusting patient–physician relationship, using an in-depth history and targeted physical examination, and then considering limited corresponding imaging and laboratory testing can help localize potential pain contributors. A key limitation stated is that the available imaging and laboratory work is limited in this context, and evaluation is more difficult because chronic pelvic pain is often multifactorial. Relevance to endometriosis: the review cites diagnostic accuracy evidence for transvaginal ultrasound for non-invasive diagnosis of bowel endometriosis and also discusses CA-125 performance in detecting endometriosis, though the paper’s main focus is the general approach to evaluating chronic female pelvic pain.

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Abstract

Chronic pelvic pain is a condition defined by pelvic pain for more than six months which is severe enough to cause functional disability or require treatment. When pain becomes a chronic condition, it is more challenging to evaluate and treat. Chronic pelvic pain patients often have multiple factors contributing to their pain. Here, we review the approach to the evaluation of chronic female pelvic pain. It is important to establish a trusting patient-physician relationship. When evaluating a female patient with chronic pelvic pain, an in-depth history and targeted physical exam can localize contributors to pain. While limited, corresponding imaging and laboratory work should also be considered.
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Abstract

Chronic pelvic pain is a condition defined by pelvic pain for more than six months which is severe enough to cause functional disability or require treatment. When pain becomes a chronic condition, it is more challenging to evaluate and treat. Chronic pelvic pain patients often have multiple factors contributing to their pain. Here, we review the approach to the evaluation of chronic female pelvic pain. It is important to establish a trusting patient–physician relationship. When evaluating a female patient with chronic pelvic pain, an in-depth history and targeted physical exam can localize contributors to pain. While limited, corresponding imaging and laboratory work should also be considered. * These authors contributed equally to the writing of this article. -

References

- 1 Mathias SD, Kuppermann M, Liberman RF, Lipschutz RC, Steege JF. Chronic pelvic pain: prevalence, health-related quality of life, and economic correlates. Obstet Gynecol 1996; 87 (03) 321-327 - 2 Howard FM. Chronic pelvic pain. Obstet Gynecol 2003; 101 (03) 594-611 - 3 Lamvu G. Role of hysterectomy in the treatment of chronic pelvic pain. Obstet Gynecol 2011; 117 (05) 1175-1178 - 4 Frantsve LM, Kerns RD. Patient-provider interactions in the management of chronic pain: current findings within the context of shared medical decision making. Pain Med 2007; 8 (01) 25-35 - 5 Stewart MA. Effective physician-patient communication and health outcomes: a review. CMAJ 1995; 152 (09) 1423-1433 - 6 Powell RA, Downing J, Ddungu H, Mwangi-Powell FN. Pain history and pain assessment. In: Kopf A, Patel NB. , eds. Guide to Pain Management in Low-Resource Settings. Seattle, WA: International Association for the Study of Pain; 2010: 67-78 - 7 The International Pelvic Pain Society. Research Committee. Pelvic Pain Assessment Form. Birmingham, Alabama: The International Pelvic Pain Society. Available at: https://www.pelvicpain.org/IPPS/Professional/Documents-Forms/IPPS/Content/Professional-Patients/Documents_and_Forms.aspx?hkey=2597ab99-df83-40ee-89cd-7bd384efed19 . Accessed July 13, 2018 - 8 World Health Organization 2016 WHO guidelines for the treatment of Genital Herpes Simplex Virus. Available at: http://who.int/reproductivehealth/publications/rtis/genital-HSV-treatment-guidelines/en/ . Accessed November 1, 2018 - 9 Steege JF, Siedhoff MT. Chronic pelvic pain. Obstet Gynecol 2014; 124 (03) 616-629 - 10 Walker E, Katon W, Harrop-Griffiths J, Holm L, Russo J, Hickok LR. Relationship of chronic pelvic pain to psychiatric diagnoses and childhood sexual abuse. Am J Psychiatry 1988; 145 (01) 75-80 - 11 Walling MK, Reiter RC, O'Hara MW, Milburn AK, Lilly G, Vincent SD. Abuse history and chronic pain in women: I. Prevalences of sexual abuse and physical abuse. Obstet Gynecol 1994; 84 (02) 193-199 - 12 Okaro E, Condous G, Khalid A. , et al. The use of ultrasound-based ‘soft markers’ for the prediction of pelvic pathology in women with chronic pelvic pain--can we reduce the need for laparoscopy?. BJOG 2006; 113 (03) 251-256 - 13 Champaneria R, Abedin P, Daniels J, Balogun M, Khan KS. Ultrasound scan and magnetic resonance imaging for the diagnosis of adenomyosis: systematic review comparing test accuracy. Acta Obstet Gynecol Scand 2010; 89 (11) 1374-1384 - 14 Hudelist G, English J, Thomas AE, Tinelli A, Singer CF, Keckstein J. Diagnostic accuracy of transvaginal ultrasound for non-invasive diagnosis of bowel endometriosis: systematic review and meta-analysis. Ultrasound Obstet Gynecol 2011; 37 (03) 257-263 - 15 Ignacio EA, Dua R, Sarin S. , et al. Pelvic congestion syndrome: diagnosis and treatment. Semin Intervent Radiol 2008; 25 (04) 361-368 - 16 Rozenblit AM, Ricci ZJ, Tuvia J, Amis Jr ES. Incompetent and dilated ovarian veins: a common CT finding in asymptomatic parous women. AJR Am J Roentgenol 2001; 176 (01) 119-122 - 17 Steenbeek MP, van der Vleuten CJM, Schultze Kool LJ, Nieboer TE. Noninvasive diagnostic tools for pelvic congestion syndrome: a systematic review. Acta Obstet Gynecol Scand 2018; 97 (07) 776-786 - 18 Mol BW, Bayram N, Lijmer JG. , et al. The performance of CA-125 measurement in the detection of endometriosis: a meta-analysis. Fertil Steril 1998; 70 (06) 1101-1108

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