Management of persistent pelvic pain in girls and women

Abstract

Background: Persistent pelvic pain (PPP) is estimated to affect 15-25% of women. Despite this, few guidelines for management are available and few medical practitioners feel adequately skilled to manage the complex range of symptoms that present. Given the numbers of girls and women affected, general practitioners (GPs) will see the majority of patients with this condition. Objectives: This article provides a practical framework for the clinical assessment and management of PPP in general practice. It aims to assist GPs care for these patients effectively and confidently. PPP is considered in four parts: pain from pelvic organs; the musculoskeletal response to pain; central sensitisation of nerve pathways; and the psychological sequelae of chronic pain. Management is supported by evidence where available, with useful references included for further reading. Discussion: A GP with an interest in this area is in a good position to effectively care for the majority of women with pelvic pain, in conjunction with other health professionals including gynaecologists, pelvic physiotherapists, psychologists, pain physicians, dieticians and urologists as required.