Surgical Treatment of Pelvic Pain

Abstract Despite the multitude of non-gynecological symptoms that can contribute to CPP, the gynecologist often feels compelled to intervene, and evaluation and treatment of pelvic pain account for a significant number of surgeries. An accurate patient history is important to identify the source of pain, and help establish trust between patient and provider. It should identify location of pain, onset, duration, timing of symptoms, and pain severity and quality. Prior to performing surgery, all attempts should be made to maximize medical therapy for at least 6–12 months. Mainstays of medical therapy include analgesics and antidepressants, but therapy should also target specific conditions such as interstitial cystitis, irritable bowel syndrome, or endometriosis, if such conditions can be identified. If medical treatment is not effective or the practitioner believes surgery will aid medical therapy, then procedures such as hysterectomy, lysis of adhesions, and neuroablative and neural release/decompression procedures can be performed.