Management of Pelvic Pain in Older Women

Chronic pelvic pain (CPP) is defined as intermittent or constant pain in the lower abdomen or pelvis for at least 6 months in duration, with subsequent impact on the ability to attend to daily living activities. Gynecologists have traditionally focused on the organ-specific approach or viscera to explain or identify the pain source. It is important to recognize that as many as 55 % of women presenting with CPP will have no well-defined etiology following completion of all investigations. CPP is fairly common, with an estimated prevalence of 3.8 % in the adult female population. It is the impetus for 10 % of gynecologic referrals, 12 % of hysterectomies, and 40 % of laparoscopic procedures. The socioeconomic CPP cost is considerable, with estimated direct health care cost of $880 million per year in the United States, besides $2 billion dollars direct and indirect costs annually. Of these women, 15 % report missing work, and 45 % note experiencing reduced productivity. This chapter will provide a comprehensive summary of chronic pelvic pain management in older women for the generalist and to facilitate appropriate investigation and management

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