The epidemiology of chronic pelvic pain in women

Objectives - This study aimed to estimate for the first time in the UK: (1) the prevalence and incidence of chronic pelvic pain (CPP) in primary care, the duration of symptoms, and patterns of diagnosis and referral; (2) the prevalence of CPP in the community, and its overlap with other types of pelvic pain, irritable bowel syndrome (IBS) and genito-urinary symptoms. Pain severity, use of health care, functioning and well-being, and factors associated with CPP were also investigated. Methods - (1) Retrospective analysis of the MediPlus UK Primary Care Database, using data for 1991-1995 of 278,509 women aged 12-70. CPP cases were identified on the basis of relevant contacts with practices. Duration of CPP and patterns of diagnosis and referral were investigated in a cohort of 5,051 incident cases followed for 3-4 years from their first contact for pelvic pain. (2) Postal questionnaire survey of 4,000 randomly selected women aged 18-50 in Oxfordshire. Cases were women reporting CPP in the last 3 months, with sub-groups classified according to cumulative pain duration in the last 12 months. Main results - (1) The annual prevalence of CPP in primary care was 38.3/1,000 (95% CI: 37.5-39.0), comparable to asthma (37/1,000) and back pain (41/1,000). The most common diagnoses given to incident cases were IBS and cystitis, but a quarter received no diagnosis and only 40% had a specialist referral. A third of incident cases had persistent symptoms after 2 years. 2) The community prevalence of CPP in women was 24.0% (95% CI: 22.1-25.8). CPP cases had a high prevalence of dysmenorrhoea (90%), dyspareunia (50%), IBS (39%), and genitourinary symptoms (24%). CPP cases of 'long' duration were much more affected in terms of pain severity, use of health care, and physical impairment than 'short' duration cases. All women with CPP appeared affected in terms of anxiety about their symptoms. Conclusions - This study provided the first evidence of a high prevalence of CPP in primary care and the community. However, CPP cases varied substantially in the degree to which they were affected by their pain in physical terms. The anxiety in women with CPP about their symptoms emphasises the need for more information about CPP and its possible causes.