The enigma of chronic pelvic pain

Description/Abstract

Chronic pelvic pain (CPP) remains a difficult gynaecological ‘headache’. Despite its prevalence in 15% of women in the general population,
there have been limited advances made in the last decade in terms of its clinical management. In this article, we review the current
evidence available in the treatment of patients with CPP and also discuss some of the important management strategies that may prove
valuable. It is important to individualise treatment based on each patient’s history, signs and symptoms. The currently available information
about the treatment of women with CPP provides some support for the use of ultrasound scanning as an aid to counselling and
reassurance, the use of progestogen (medroxyprogesterone acetate) or goserelin for pelvic congestion and (with the aim of improved
function and self-rating) the use of a multidisciplinary approach to assessment and treatment. Adhesiolysis has not been shown to be of
benefit other than in women with severe adhesions. Ablation of endometriosis may provide benefit when this is the cause of CPP. Selective
serotonin re-uptake inhibitor (SSRI) antidepressants have not been shown to be of benefit. The management of CPP remains an enigma
and much needs to be done in terms of basic science and clinical research to address this problem.