Chronic Pelvic Pain

Chronic Pelvic Pain (CPP) is defined (somewhat arbitrarily) as pain in a womanโ€™s pelvic area for at least 3-6 months, that isnโ€™t cyclical.ย  The latter means that it isnโ€™t clearly related to menstrual periods; it may come and go, but not in a regular pattern.ย  CPP is a diagnosis of exclusion, meaning that no other disease is found by history, physical exam, and standard tests (see Chronic Abdominal / Pelvic Pain for the diagnostic approach).

Current thought suggests that CPP is one of several conditions due to โ€œcentral sensitization.โ€ย  This means that the brain somehow interprets similar stimuli as more painful in some people than others.ย  This may well be genetic, or related to past experiences, physical or psychological.ย  Other such conditions include Irritable Bowel Syndrome, Interstitial Cystitis, Fibromyalgia, chronic Headaches and Back Pain.ย  The concept is more of a hypothesis than proven fact.ย  For CPP in particular, prior sexual abuse or trauma may be an inciting factor.

Treatment varies from simple pain medications, to other medications which attempt to stop pain from coming on, to physical therapy, and/or injections (into muscle, or as nerve blocks).ย  Hormone therapy may be recommended, especially if there seems to be an episodic pattern to pain, which might suggest Endometriosis as a cause (diagnosed most reliably by laparoscopy).ย  Opioid medications (narcotics) are not recommended.ย  Psychological pain management may be helpful, as may exercise.ย  Surgery to remove nerve centers or hysterectomy may be a last resort.

Like all such chronic problems, most patients gain degrees of relief from basic management.  It is only a minority whose pain remains persistent.

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