Epidemiology of chronic pelvic pain

The epidemiology of chronic pelvic pain (CPP) is very difficult to investigate because of: 1) a lack of consensus of its clinical definition across studies; 2) its multi-causal origin; and 3) study design complications. Using the most common definition of CPP (lower abdominal pain of at least 6 months' duration, excluding pain solely related to pregnancy, menstruation, or intercourse), the prevalence of CPP among women of reproductive age in the general population is estimated to be as high as 25%. The level to which women are affected by their symptoms varies, but concern regarding the cause of the pain is common place. Despite this concern, many women with CPP in the general population do not seek health care, or, if they do, do not get referred to secondary care and cease seeking medical advice after a period of time. Indeed, the diagnoses most commonly received-IBS and 'stress'-are diagnostic labels given in primary care that do not necessarily require specialist investigations. Women seen in secondary or tertiary referral clinics are a highly selected group who often have had symptoms for several years. The investigation of the aetiology of CPP through assessment of 'risk factors' remains highly complicated because of the complexity of the condition, but more so because prospective cohort studies are required to assess unbiased exposure prior to onset of symptoms.