Chronic Pelvic Pain in Women: Evaluation and Treatment

Abstract

Chronic pelvic pain affects up to 26% of individuals with female anatomy and is defined as at least 6 months of pain that is perceived to originate in the pelvis. Chronic pelvic pain is highly correlated with psychosocial comorbidities, including depression, anxiety, and history of abuse. Although common causes include irritable bowel syndrome, bladder pain syndrome (interstitial cystitis), pelvic floor dysfunction, and endometriosis, chronic pelvic pain is most often the result of multiple coexisting pain conditions and central nervous system hypersensitivity. Evaluation requires a biopsychosocial approach, beginning with a complete history and physical examination to ensure an accurate and timely diagnosis. Diagnostic laboratory and imaging tests are of limited utility and should be tailored to investigate presenting symptoms and examination findings. When a single etiology is identified, treatment should follow disease-specific guidelines; otherwise, the management of undifferentiated chronic pelvic pain should follow an interdisciplinary approach to improve function and quality of life. Multimodal treatment includes pain education, self-care, behavioral therapy, physical therapy, and pharmacotherapy, with limited indications for surgical interventions. Regular follow-up to review progress is necessary. Clinicians should have a low threshold for referral to interdisciplinary pain management or other subspecialties when improvement is not seen.