Women and Pelvic pain

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Most women (and some men), sometime in their lives experience pelvic pain (when at least 3 mths, called chronic pelvic pain (CPP)). This is a poorly understood condition that likely represents abnormal neurological function, either in the peripheral nervous system or central nervous system. Mainly different etiologies have been proposed for CPP, but a major problem is that virtually none of them have been validated. Commonly proposed etiologies include:

• endometriosis (very controversial)
• infection or post-infectious neurological hypersensitivity
• exaggerated bladder, bowel, or uterine pain sensitivity (also known as visceral pain)
• ovarian cysts, uterine leiomyoma - often found in asymptomatic patients as well, however
• less common emergencies: ovarian torsion - sudden loss of circulation to the ovary, appendicitis - infection of one part of the intestine, with right lower abdominal pain, ectopic pregnancy - where an early pregnancy grows outside of the uterus, and can cause sudden, heavy intra-abdominal bleeding

Women with symptoms of pain may want to see a gynecologist if problems don't go away after a few days, and workup should begin with a careful history and examination, followed by a pregnancy test. Some women may also need bloodwork or additional imaging studies, and a handful may also benefit from having surgical evaluation using small telescopes (laparoscopy). Many women will also benefit from a consultation with a physical therapist, a trial of anti-inflammatory medications, hormonal therapy, or even neurological agents.

This is a condition that although common, direly needs to be studied more closely.

External links

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• International Pelvic Pain Society
• American Pain Society
• Advanced Gynecology Studies
• Evanston Northwestern Healthcare Division of Endoscopic Surgery and Chronic Pelvic Pain
• University of Michigan Pelvic Pain Program
• University of North Carolina Pelvic Pain Program
• Endometriosis Research Center
• (http://www.endometriosis.org endometriosis.org)
• Endometriosis Association

Gynecology | Nociception | Pain