FIGO–IPPS consensus statement: Addressing the global unmet needs of women with chronic pelvic pain

CPP inflicts significant suffering and economic burden upon millions of women worldwide, yet it remains a neglected area of health research and policy. This disparity between impact and resource allocation is unacceptable. This consensus statement calls for urgent action to prioritize CPP by promoting the following key actions: Establishing a consensus definition of chronic pelvic pain: the first step must be to obtain a consensus on the definition of CPP, agreed upon by multiple societies and advocacy groups. A clear definition paves the way for the development of a classification system, akin to PALM‐COEIN 43 for abnormal uterine bleeding, which will enable clinicians to accurately diagnose CPP and enhance trainee and health professional education. 43 An established definition will also assist researchers to precisely identify study populations, promote standardized data collection, and aid with the interpretation of results across studies, including systematic reviews and meta‐analyses. A clear definition empowers patients by giving them a name for their condition, validating their experience, and facilitating communication with healthcare professionals. Finally, a consensus definition provides policymakers with a focus for understanding the scope of the problem and allocating resources appropriately. Empower women and reduce stigma: women with CPP play a vital role in changing the landscape of care for this condition. Their lived experiences are invaluable in identifying gaps in care, developing more effective and compassionate treatment approaches, and driving improvements in access to care. The International Federation of Gynecology and Obstetrics (FIGO) and International Pelvic Pain Society (IPPS) call on affiliated societies to partner with women with CPP and patient advocacy groups to develop and implement strategies that not only remove stigma and create a supportive environment where women feel empowered to seek help, but also actively engage them in promoting education and advancing research on this condition. Their participation in studies, sharing of experiences, and input on research priorities are vital for enhancing our understanding of CPP mechanisms, developing innovative diagnostic tools, discovering more effective treatments, and developing policies that improve care. This type of collaboration with patients can be fostered through research, awareness campaigns, educational initiatives, and open dialogue. Expand access to quality transdisciplinary care: increasing access to transdisciplinary care for women with CPP requires a multifaceted approach. First, improving physician education is essential, ensuring that healthcare professionals across various specialties (e.g. gynecology, primary care, physical therapy, mental health) are well‐versed in the complexities of CPP and the benefits of collaborative care. Simultaneously, developing practical tools and resources, such as standardized assessment protocols, referral pathways, and patient education materials, can facilitate coordinated care delivery. Disseminating evidence‐based clinical guidelines will ensure consistent, high‐quality care across different healthcare settings. Integrating CPP care into primary care settings will enable early diagnosis, timely referral to specialized services, and improved care coordination. Importantly, these resources must be adaptable to countries with varied cultures and socioeconomic means. It is imperative that healthcare professionals and models of care shift away from treating CPP as an acute condition to a chronic care model that prioritizes long‐term management, physical and emotional rehabilitation, and mental well‐being. Policies should encourage the establishment of transdisciplinary pain clinics or networks, where specialists can work together, to provide comprehensive and integrated care. Finally, an evidence‐based biopsychosocial and trauma‐informed approach must be incorporated into all aspects of evaluation and management. This approach recognizes that women with CPP come from diverse backgrounds and varying socioeconomic statuses, and may have experienced traumatic events such as war, poverty, or abuse, all of which can significantly influence their pain experience and response to treatment. By acknowledging these factors and shifting the focus from “curing” an acute problem to managing a long‐term health condition, healthcare providers can promote well‐being and create a safe and supportive environment, foster trust, and facilitate more effective, patient‐centered care. Enhance education and awareness: CPP is often misunderstood, with many women suffering in silence. To address this, public awareness campaigns are needed to educate women, their families, and communities about CPP symptoms, diagnosis, and treatment options. These campaigns must challenge the harmful notion that pelvic pain is an acceptable or normal part of being a woman. By reducing stigma and encouraging help‐seeking behavior, we can empower women to take control of their health and seek timely care. Simultaneously, healthcare providers need comprehensive education and training to effectively diagnose and manage CPP. This includes promoting a transdisciplinary approach, utilizing the biopsychosocial model, and ensuring cultural sensitivity in all patient interactions. Providing women with culturally relevant educational resources will further empower them to actively participate in their care and navigate the healthcare system with confidence. Prioritizing research and funding: there are multifactorial causes for CPP and all of them are under‐studied. FIGO and IPPS emphasize the urgent need to recognize the underestimated impact of CPP. This underestimation leads to inadequate funding, limited recognition within healthcare systems, and ultimately, suboptimal care for millions of women. To address this, a rigorous assessment of CPP's full economic burden, including the often‐overlooked costs of unpaid work and lost productivity, is crucial. This comprehensive understanding will inform resource allocation and prioritize effective interventions. Furthermore, research efforts must explore the knowledge gaps, stigma, and barriers to care that perpetuate the cycle of neglect. Increased investment in transdisciplinary CPP research is essential. This research should prioritize innovative diagnostic tools, non‐surgical interventions that are more easily accessible, tailoring treatments to individual needs, and therapies that improve all aspects of physical, mental, and emotional health. Including CPP in global health agendas and research funding priorities is not only a matter of justice for women but is also essential for the well‐being and economic prosperity of societies worldwide. Developing dedicated CPP sections within healthcare societies: all relevant healthcare societies, including those representing gynecology, urology, gastroenterology, primary care, pain management, physical therapy, and behavioral and mental health, are strongly encouraged to develop dedicated sections, committees, or working groups specifically focused on CPP. FIGO and IPPS are committed to universal gynecologic health coverage and work as hard on creating preventive care strategies as they do on access to the best medical, surgical, and emergency gynecologic care. Establishing a consensus definition of chronic pelvic pain: the first step must be to obtain a consensus on the definition of CPP, agreed upon by multiple societies and advocacy groups. A clear definition paves the way for the development of a classification system, akin to PALM‐COEIN 43 for abnormal uterine bleeding, which will enable clinicians to accurately diagnose CPP and enhance trainee and health professional education. 43 An established definition will also assist researchers to precisely identify study populations, promote standardized data collection, and aid with the interpretation of results across studies, including systematic reviews and meta‐analyses. A clear definition empowers patients by giving them a name for their condition, validating their experience, and facilitating communication with healthcare professionals. Finally, a consensus definition provides policymakers with a focus for understanding the scope of the problem and allocating resources appropriately. Empower women and reduce stigma: women with CPP play a vital role in changing the landscape of care for this condition. Their lived experiences are invaluable in identifying gaps in care, developing more effective and compassionate treatment approaches, and driving improvements in access to care. The International Federation of Gynecology and Obstetrics (FIGO) and International Pelvic Pain Society (IPPS) call on affiliated societies to partner with women with CPP and patient advocacy groups to develop and implement strategies that not only remove stigma and create a supportive environment where women feel empowered to seek help, but also actively engage them in promoting education and advancing research on this condition. Their participation in studies, sharing of experiences, and input on research priorities are vital for enhancing our understanding of CPP mechanisms, developing innovative diagnostic tools, discovering more effective treatments, and developing policies that improve care. This type of collaboration with patients can be fostered through research, awareness campaigns, educational initiatives, and open dialogue. Expand access to quality transdisciplinary care: increasing access to transdisciplinary care for women with CPP requires a multifaceted approach. First, improving physician education is essential, ensuring that healthcare professionals across various specialties (e.g. gynecology, primary care, physical therapy, mental health) are well‐versed in the complexities of CPP and the benefits of collaborative care. Simultaneously, developing practical tools and resources, such as standardized assessment protocols, referral pathways, and patient education materials, can facilitate coordinated care delivery. Disseminating evidence‐based clinical guidelines will ensure consistent, high‐quality care across different healthcare settings. Integrating CPP care into primary care settings will enable early diagnosis, timely referral to specialized services, and improved care coordination. Importantly, these resources must be adaptable to countries with varied cultures and socioeconomic means. It is imperative that healthcare professionals and models of care shift away from treating CPP as an acute condition to a chronic care model that prioritizes long‐term management, physical and emotional rehabilitation, and mental well‐being. Policies should encourage the establishment of transdisciplinary pain clinics or networks, where specialists can work together, to provide comprehensive and integrated care. Finally, an evidence‐based biopsychosocial and trauma‐informed approach must be incorporated into all aspects of evaluation and management. This approach recognizes that women with CPP come from diverse backgrounds and varying socioeconomic statuses, and may have experienced traumatic events such as war, poverty, or abuse, all of which can significantly influence their pain experience and response to treatment. By acknowledging these factors and shifting the focus from “curing” an acute problem to managing a long‐term health condition, healthcare providers can promote well‐being and create a safe and supportive environment, foster trust, and facilitate more effective, patient‐centered care. Enhance education and awareness: CPP is often misunderstood, with many women suffering in silence. To address this, public awareness campaigns are needed to educate women, their families, and communities about CPP symptoms, diagnosis, and treatment options. These campaigns must challenge the harmful notion that pelvic pain is an acceptable or normal part of being a woman. By reducing stigma and encouraging help‐seeking behavior, we can empower women to take control of their health and seek timely care. Simultaneously, healthcare providers need comprehensive education and training to effectively diagnose and manage CPP. This includes promoting a transdisciplinary approach, utilizing the biopsychosocial model, and ensuring cultural sensitivity in all patient interactions. Providing women with culturally relevant educational resources will further empower them to actively participate in their care and navigate the healthcare system with confidence. Prioritizing research and funding: there are multifactorial causes for CPP and all of them are under‐studied. FIGO and IPPS emphasize the urgent need to recognize the underestimated impact of CPP. This underestimation leads to inadequate funding, limited recognition within healthcare systems, and ultimately, suboptimal care for millions of women. To address this, a rigorous assessment of CPP's full economic burden, including the often‐overlooked costs of unpaid work and lost productivity, is crucial. This comprehensive understanding will inform resource allocation and prioritize effective interventions. Furthermore, research efforts must explore the knowledge gaps, stigma, and barriers to care that perpetuate the cycle of neglect. Increased investment in transdisciplinary CPP research is essential. This research should prioritize innovative diagnostic tools, non‐surgical interventions that are more easily accessible, tailoring treatments to individual needs, and therapies that improve all aspects of physical, mental, and emotional health. Including CPP in global health agendas and research funding priorities is not only a matter of justice for women but is also essential for the well‐being and economic prosperity of societies worldwide. Developing dedicated CPP sections within healthcare societies: all relevant healthcare societies, including those representing gynecology, urology, gastroenterology, primary care, pain management, physical therapy, and behavioral and mental health, are strongly encouraged to develop dedicated sections, committees, or working groups specifically focused on CPP. FIGO and IPPS are committed to universal gynecologic health coverage and work as hard on creating preventive care strategies as they do on access to the best medical, surgical, and emergency gynecologic care. In summary, FIGO and IPPS unequivocally call for universal access to quality healthcare for all women with CPP. Achieving the goals outlined in this consensus statement will require a concerted and collaborative effort from all stakeholders, including scientific societies, healthcare providers, researchers, policymakers, patient advocates, and women with CPP themselves. We believe that a multi‐pronged approach, encompassing individual empowerment, healthcare system reform, and global policy commitments, is essential for driving meaningful change. Through collaborative action and a shared dedication to improving women's health, we can reduce the global burden of CPP and enhance the well‐being of millions of women worldwide (Table  1 ). Call to action priorities. Allow for classification for researchers and healthcare providers Empower women by providing a diagnosis Provide policymakers with scope of the issue Improves access care Encourages advocacy Drives the research agenda Opportunity to disseminate education Move to a chronic care model Avoid unnecessary tests and interventions Use a patient‐centered approach To the public To healthcare providers Bridge knowledge gaps Develop innovative therapies with measured outcomes Use evidence to guide practice Recognize the complexity of CPP Establish centers for provider training Encourage universal healthcare access Abbreviation: CPP, chronic pelvic pain.

CPP poses a significant burden on women's lives, impacting their physical, emotional, and social well‐being. 1 , 26 , 28 The persistent pain can disrupt daily activities, impairing work productivity, household responsibilities, and even basic self‐care. 24 , 28 Emotionally, CPP can lead to anxiety, depression, feelings of isolation, straining relationships, and diminishing quality of life. 16 , 28 , 29 Many women experience pain during sexual activity, further impacting intimacy and self‐esteem. 26 , 28 Beyond individual suffering, CPP also strains healthcare systems and contributes to economic losses due to decreased productivity and increased medical expenses. Although the financial impact of CPP varies considerably across countries due to differences in healthcare systems, economic contexts, and research availability, the burden on society as a whole is substantial. 29 In HICs like the USA, the estimated annual cost reaches $2.8 billion, 20 , 29 , 30 while in Japan, individual women face yearly expenses in the range of ¥191 680–¥246 488. 20 , 30 Australian women experience annual costs in the range of $16 970–$20 898. 20 Importantly, these figures primarily capture direct medical expenses and may not fully reflect the indirect healthcare costs not accessed by a publicly funded system. 30 , 31 More importantly, it does not measure the societal costs, such as lost productivity, disability, and diminished quality of life, which further amplify the economic burden. 19 , 31 The economic impact of CPP may also be significantly underestimated due to the consistent omission of unpaid work, typically performed by women, despite its crucial role in societal functioning. 31 Furthermore, limited data from LMICs likely mask an even greater economic hardship faced by women in these regions. 4 , 30 To accurately assess the full health economic impact of CPP, including direct, indirect, and societal costs, increased research investment is essential in both HICs and LMICs. 4 , 13 , 19 , 30 A crucial component of this research must be the development of standardized methodologies for capturing indirect costs, particularly the value of unpaid work, enabling more accurate cross‐national comparisons and ultimately informing resource allocation for effective pain management. 4 , 30 , 31

Many providers lack a comprehensive understanding of the complex nature of pelvic pain, including its diverse etiologies, overlapping symptoms, and the importance of a biopsychosocial approach to care. 38 This educational gap often leads to misdiagnosis, delayed diagnosis, and inappropriate or ineffective treatment. 10 , 11 , 39 Women's pain is frequently dismissed or minimized, often by frustrated providers, resulting in patient frustration and a sense of being unheard, further compounding their suffering. 28 , 40 Inadequate education may also result in inequitable care, fragmented approaches, and, ultimately, poor patient outcomes. 11 Fortunately, deficiencies in training can be addressed by improving training resources and investing in robust, standardized education for healthcare professionals across multiple disciplines, including primary care physicians, gynecologists, urologists, gastroenterologists, physical therapists, and mental health professionals. 11 , 39

Women experiencing CPP often face a frustrating lack of accessible and reliable educational resources. 28 , 34 The complexity of CPP, coupled with the stigma surrounding pelvic health, makes it difficult for women to find clear information about their condition, understand treatment options, and navigate the healthcare system effectively. 33 , 41 This scarcity of patient‐centered resources leaves many women feeling isolated, confused, and disempowered. 3 , 33 Furthermore, while patient advocacy groups play a vital role in raising awareness and driving change, their reach and resources are often limited. 42 Increased funding and support for patient education and advocacy resources are needed for empowering women with CPP, validating their experiences, and ensuring their voices are heard in research, policy, and healthcare delivery. 1 Developing culturally sensitive and linguistically appropriate resources is also essential to address disparities in access to information and support. 1 , 3 , 15

All authors contributed to the conception, design, writing, and review of the paper. All authors agree to be accountable for the final publication.

None.

The global health community needs to prioritize a move away from the current fragmented and often inadequate approach to CPP care. Transdisciplinary care using the biopsychosocial model, while recognized as the standard of care, remains inaccessible to most women. 33 , 34 Admittedly, applying a biopsychosocial model to care for CPP patients can be complex and many of them experience delayed or inaccurate care due to limited access to specialists who have the proper knowledge to spearhead management strategies. 1 , 2 , 3 , 33 For instance, women with endometriosis, a common subset of the CPP population, have reported delays of 4–11 years from the onset of symptoms to diagnosis. 15 , 35 , 36 , 37 Disparities in access to quality care have been reported across LMICs and HICs, particularly for underserved populations. 4 , 22 , 24 , 30 The resulting lack of recognition and access leaves women powerless and stigmatized, leading to the overuse of surgical interventions with irreversible consequences, such as menopause and infertility.

Despite the significant global health, economic, and social impact, CPP suffers from a critical lack of recognition within health policy agendas and research funding priorities. 1 This underinvestment hinders progress, 21 , 23 , 29 perpetuating a cycle of under‐recognition, underfunding, and limited access, 31 , 32 resulting in unnecessary suffering and substantial economic burdens. 1 , 3 , 13 The consequences are far‐reaching, resulting in unnecessary suffering for millions of women, substantial monetary burdens on individuals, families, and healthcare systems, and a significant impediment to women's overall well‐being and societal participation. 1 , 3 , 19 This neglect not only reflects a general dismissal of women's health concerns but also highlights societies and policymakers' lack of awareness of the far‐reaching impacts of overlooking CPP. 1 , 19 To ensure that women with CPP receive the necessary care, the cycle of neglect must be broken by explicitly incorporating CPP into both local and global health agendas. 4 , 5 , 6 This necessitates a commitment to increase and sustain investment in research and improve resource allocation. 1 , 4 , 28 Data collection and integration into national strategies are essential to this endeavor. 1 , 4 , 29 Analysis of the prevalence, burden, and economic impact of CPP will inform policy decisions and resource allocation. Therefore, CPP‐specific metrics must be developed for tracking progress in research funding and policy implementation. 1 , 5 , 28 , 30

The authors have no conflicts of interest.