Laparoscopic findings in women with chronic pelvic pain

Abstract

Objective: This study was undertaken to assess the spectrum of pelvic pathology observed at laparoscopy in women with chronic pelvic pain, and to compare women with an identifiable cause of pain to those with no visible pelvic pathology, with regard to symptomatology and demography.

Design: Retrospective case control study reviewing laparoscopy reports and patient records.

Setting: Department of Obstetrics and Gynaecology, Groote Schuur Hospital.

Patients: One hundred and thirty-six consecutive women undergoing laparoscopic assessment for undiagnosed pelvic pain of at least 6 months' duration, between 1989 and 1991.

Main outcome measures: The presence of endometriosis, pelvic adhesions, other pelvic pathology and 'negative' laparoscopic findings was assessed. The association between pelvic pathology and specific symptomatology, fertility, contraceptive use, past pelvic surgery, ethnic group and smoking is examined.

Results: No cause of pain was identified at laparoscopy in 30% of these patients, while endometriosis was found in 16% of women and pelvic adhesions in 40%. The 41 women with no identifiable laparoscopic abnormality did not differ significantly from the 95 with pelvic abnormalities in respect of age, parity, duration of pain, frequency of dysmenorrhoea and dyspareunia or the presence of gastro-intestinal or urinary symptoms. However, injectable hormonal contraception use was more common in the group with negative laparoscopic findings and smoking was more common among the women with pelvic pathology.

Conclusion: Chronic pelvic pain with a laparoscopically normal pelvis is a common problem in Cape Town, occurring with a frequency similar to that reported from various overseas centres. Women with this problem are not readily identified by demographic profile or symptom complex.