Management of Pelvic Pain

Pelvic pain in women is a diverse condition, with a wide variety of etiologies both related and unrelated to the female reproductive organs. In addition to pain of gynecologic origin, there may be urologic, gastrointestinal, musculoskeletal, neurologic, and vascular origins to pelvic pain. Etiologies range from infection, inflammation, menstruation, pregnancy, neoplasm, adnexal torsion, alterations of anatomy, adhesive disease, uterine fibroids, endometriosis, kidney stones, irritable bowel syndrome, painful bladder syndrome, pelvic organ prolapse, pelvic congestion, to vascular abnormalities. Pelvic pain is divided into acute and chronic pain, and while there can be significant overlap in etiologies, it is important to quickly rule out or identify critical or life-threating causes of acute pelvic pain. As management of pelvic pain varies significantly by etiology, a careful history and physical exam followed by appropriate laboratory and diagnostic studies is crucial to narrow the differential diagnosis and improve likelihood of effective symptom management. Similar content being viewed by others

Agarwal SK, Chapron C, Giudice LC, Laufer MR, Leyland N, Missmer SA, Singh SS, Taylor HS. Clinical diagnosis of endometriosis: a call to action. Am J Obstet Gynecol. 2019;220(4):354.e1–354.e12. https://doi.org/10.1016/j.ajog.2018.12.039. Epub 2019 Jan 6 Ahanagari A. Prelavance of chronic pelvic pain among women: an updated review. Pain Physcian. 2014;17(2):E141. American College of Obstetrics and Gynecology; Chronic Pelvic Pain: Practice Bulletin, number 281, March 2020. As-Sanie, S. Causes of chronic pelvic pain in nonpregnant women. IN UpToDate, Sharp HT, and Eckler K (eds), Waltham 2019. Beard RW, Kennedy RG, Gangar KF, Stones RW, Rogers V, Reginald PW, Anderson M. Bilateral oophorectomy and hystectomy in the treatment of intractable pelvic pain associate with pelvic congestion. BJOG. 1991;98(10):988–92. Brown HE, Collins JJ, Farquhar C, Fedorkow DM, Vandekerchova P. Ovulation suppression for endometriosis. Cochrane Database Syst Rev. 2007;3:CD000155. (ISSN:1469-493X) Cao W, Lu F, Feng WW, Ding JX, Hua KQ. Comparison of complete and incomplete excision of deep infiltrating endometriosis. Int J Clin Exp Med. 2015;8(11):21497–506. Chopin N, Vieira M, Borghese B, Foulot H, Dousset B, Coste J, et al. Operative management of deeply infiltrating endometriosis. Int J Clin Exp Med. 2015;8(11):21497–506. Chung M-H, Huh C-Y. Comparison of treatments for pelvic congestion syndrome. Tohoku J Exp Med. 2003;201(3):131–8. Diaz-Mohedo E, Hita-Contreras F, Luque-Suarez A, et al. Prevalence and risk factors or pelvic pain. Actas Urol Esp. 2014;38(5):298–303. Donnez J, Tomazewski J, Vasquez F, Bouchard P, Lemieszczuk B, Baro F, et al. Ulipristal acetate versus leuprolide acetate for uterine fibroids. N Engl J Med. 2012;366:42–432. Duffy JM, Arambage K, Correa FJ, et al. Laparoscopic surgery for endometriosis. Cochrane Database Syst Rev. 2014;(4):1–75. CD011031. Published 2014 Apr 3. https://doi.org/10.1002/14651858.CD011031.pub2 Eller-Smith OC, Nicol AL, Christianson JA. Potential mechanisms underlying centralized pain and emerging therapeutic interventions. Front Cell Neurosci. 2018;12:35:1–18. Farid H, Lau TC, Karmon AE, Styer AK. Clinical charasteristc associate with antiboitc treatment failure for tuboovarian abscess. Infect Dis Obstet Gynecol. 2016;2016:1–7. Fauconnier A, Dallongeville E, Huchon C, et al. Measurement of acute pelvic pain intensity in gynecology: a comparison of five methods. Obstet Gynecoxl. 2009;113:260. FitzGerald MP, Kotarinos R. Rehabilitation of the short pelvic floor I: background and patient evaluation. Int Urogynecol J Pelvic Dysfunct. 2003;14(4):261. Gebhart GF. Peripheral contributions to visceral hyperalgesia. Can J Gastroenteriol. 1999;13(Suppl A):37A–41A l. Goharkhay N, Verma U, Maggiorotto F. Comparison of CT- or ultrasound-guided drainage with concomitant intravenous antibiotics vs intravenous antibiotics alone in the management of tubo-ovarian abscesses. Ultrasound Obstet Gynecol. 2007;29:65–9. Gyang A, Hartman M, Lamvu G. Musculoskeletal causes of chronic pelvic pain: what a gynecologist should know. Obstet Gynecol. 2013;121(3):645–50. Hibner M. Management of chronic pelvic pain: a practical manual. Cambridge University Press; 2021. Howard F. Introduction. In: Howard F, Perry C, Carter J, El-Minawi A, editors. Pelvic pain diagnosis and management. Philadelphia: Lippincott Williams & Wilkins; 2000. Howard FM. The role of laparoscopy in chronic pelvic pain: promise and pitfalls. Obstet Gynaecol Surv. 2003;48(6):357–87. Huang G, Le AL, Goddard Y, James D, Thavorn K, Payne M, Chen I. A systematic review of the cost of chronic pelvic pain in women. J Obstet Gynaecol Can. 2021;26:S1701–2163. Lamvu G, Carrillo J, Ouyang C, Rapkin A. Chronic pelvic pain in women: a review. JAMA. 2021;325(23):2381–91. https://doi.org/10.1001/jama.2021.2631. PMID: 34128995 Lee D, Lee J-L. The pelvic girdle. Edinburgh: Elsevier; 2011. Moawad NS, Mahajan ST, Moniz HM, et al. Laparoscopic surgery in infertile women with minimal or mild endometriosis. New Eng J Med. 1997;337(4):217–22. Moawad NS, Mahajan ST, Moniz MH, Taylor SE, Hujrd WW. Current diagnosis and treatment of interstitial pregnancy. Am J Obstet Gynecol. 2010;202(1):15–29. Pendergast SA, Weiss JM. Screening for musculoskeletal causes of pelvic pain. Clin Obstet Gynecol. 2003;46(4):773. Rapkin AJ, Karnes ID. New hope for patients with chronic pelvic pain. Female Patient. 1988;31:100–17. Rapkin AJ, Mayer EA. Gastroenterologic causes of chronic pelvic pain. Obstet Gynecol Clin NA. 1993;20:663–83. Rizk B, Fischer AS, Lotfy HA, Turki R, Zahed HA, Malik R, et al. Recurrence of endometriosis after hysterectomy. Facts Views Vision ObGyn. 2014;6(4):219–27. Spitznagle TM, Robinson CM. Myofascial pelvic pain. Obstet Gynecol Clin N Am. 2014;41(3):409–32. Steege JF, Siedhoff MT. Chronic pelvic pain. Obstet Gynecol. 2014;124:616–29. Stovall TG, Ling FW, Crawford DA. Hysterectomy for chronic pelvic pain of presumed uterine etiology. Obstet Gynecol. 1990;75(4):676–9. The American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 218: chronic pelvic pain. Obstet Gynecol. 2020;135(3):e98–e109. The Practice Committee of the American Society for Reproductive Medicine. Treatment of pelvic pain associated with endometriosis: a committee opinion. Fertil Steril. 2014;101(4):927. Tu FF, As-Sanie S. Evaluation of chronic pelvic pain in women. In UpToDate, Sharp HT and Eckler, K (Eds), Waltham, Mass.: Wolters Kluwer Health; 2019. Wytrazek M, Huber J, Lipiec J, Kulczyk A. Evaluation of palpation, pressure algometry, and electromyography for monitoring trigger points in young participants. J Manip Physiol Ther. 2015;38(3):232–43. Author information Authors and Affiliations Corresponding author Editor information Editors and Affiliations Rights and permissions Copyright information © 2022 Springer Nature Switzerland AG About this entry Cite this entry Cox, K., Shoupe, D., Reinert, A. (2022). Management of Pelvic Pain. In: Shoupe, D. (eds) Handbook of Gynecology. Springer, Cham. https://doi.org/10.1007/978-3-319-17002-2_86-2 Download citation DOI: https://doi.org/10.1007/978-3-319-17002-2_86-2 Received: Accepted: Published: Publisher Name: Springer, Cham Print ISBN: 978-3-319-17002-2 Online ISBN: 978-3-319-17002-2 eBook Packages: Living Reference MedicineReference Module Medicine

- Acute pelvic pain - Chronic pelvic pain - Pelvic pain - Recurrent pelvic pain - Endometriosis - Adenomyosis - Myofascial pain syndrome - Dysmenorrhea - Adnexal pain - Trigger points - Leiomyomata - Glial cells - Central sensitization - Complex pelvic pain syndromes - Viscero-somatic convergence - Viscero-visceral convergence - Irritable bowel syndrome - Pelvic floor dysfunction - Abdominal wall pain - Neuropathic pain - Vulvodynia - Painful bladder syndrome