Brian P. Jacob, David C. Chen, Bruce Ramshaw, Shirin Towfigh (eds.) - The SAGES Manual of Groin Pain-Springer International Publishing (2016)

12. Chronic Pelvic Pain in Women
M. Jonathon Solnik and Matthew Thomas Siedhoff
Introduction
Our ability to provide optimal care for women who suffer from
chronic pelvic pain (CPP) has traditionally been limited, in part, by the
complexity of the presentation and the relative lack of understanding of
the mechanisms involved and data to support consistent therapeutic
options that relieve pain. Although some women can prove to be
challenging with regard to applying suitable diagnostic and treatment
paradigms, identifying a clinician who is comfortable accepting chronic
patients who can be perceived as “difficult to manage” can likewise
prove to be problematic.
Inconsistencies in nomenclature, along with the lack of a consistently
utilized definition of CPP, affect our ability to determine the
prevalence of this disorder in women, and they also contribute to the
global clinical problem. The American College of Obstetricians and
Gynecologists proposed defining CPP as noncyclic pain of 6 or more
months’ duration that localizes to the anatomic pelvis, anterior abdominal
wall at or below the umbilicus, the lumbosacral back, or the buttocks,
and is of sufficient severity to cause functional disability or lead
to medical care [ 1 ]. One general estimation of prevalence was 4 %
across different populations of women, which included pain from nongynecologic
origins [ 2 ]. Using a common set of definitions, a systematic
review of high-quality prevalence studies published by the World Health
Organization cited a range of 16.8–81 % for dysmenorrhea (pain that
occurs with menstruation), 2.1–24 % for women with noncyclic pain
(pain that occurs outside of the menstrual cycle), and 8–21.1 % for dyspareunia
(pain with intercourse) [ 3 ].
Notwithstanding, a substantial number of women are exposed to
potentially nontherapeutic surgical procedures; approximately 40 % of
diagnostic laparoscopies and 20 % of all hysterectomies are performed
© Springer International Publishing Switzerland 2016
B.P. Jacob et al. (eds.), The SAGES Manual of Groin Pain,
DOI 10.1007/978-3-319-21587-7_12
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