Chronic pelvic pain in gynaecology

Pathophysiology of visceral pain

Scoring of pain
Pain is a subjective feeling and cannot be measured objectively.

As scoring systems have been developed

* the Biberoglu-Behrman scale scoring dysmenorrhoea, chronic pelvic pain, deep dyspareunea, (and dyschesia) , pelvic nodularity and tenderness

* more elaborate visual analog scales and questionnaires

Endometriosis
Endometriosis is a prime cause of chronic pelvic pain in women. In summary:

Subtle: no pain

Typical: can be a cause of pain but many women do not have pain

Cystic: most women have severe pain but some 10 to 20% are pain free

Deep: most women have very severe pain but some 10% are without pain

Adenomyosis: probably the majority of women is pain free

Pelvic adhaesions
Adhaesions can cause pain, but probably 50% of women with adhaesions do not have pain.

Other causes
Almost any pathology can cause pain e.g.

Gynaecology: bleeding, a persistent copus luteum, myoma, hydrosalpinx, bowels

Radiated pain from the sacro-ileac joint

Treatment and Placebo effect
Since pain is so multifactoreal a careful investigation is mandatory.

Treatment of pain is associated with a high placebo effect: pain gets better for a few months after which pain starts again.

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