Causes of chronic pelvic pain

Chronic pelvic pain is a common condition affecting perhaps one in six of the adult female population. It can be extremely disabling and lead to the breakdown of relationships and loss of earning capacity. In exploring the causes of chronic pelvic pain a holistic approach should be taken which seeks to identify contributory factors rather than a single diagnosis. Pain may arise from any structure in or related to the pelvis. Gynaecological conditions such as endometriosis and adhesions secondary to pelvic infection are well known. Conditions such as irritable bowel syndrome and less commonly interstitial cystitis may be present. Musculoskeletal pain may also occur and more recently the idea of neurogenic pain is being explored. Some of these common conditions may coexist. All pain has an emotional component and for some women this may be more prominent perhaps because of features of her past or present experience. Biological psychological and social factors may all be relevant. In this chapter the current models of the aetiology of pelvic pain are discussed using the history and examination as the screening tool to identify components of the pain.