Diagnosis and Treatment of the Causes of Chronic Pelvic Pain

Ten years of clinical evaluations of women with chronic pelvic pain resulted in concern that diagnostic laparoscopic surgery is performed too frequently in these patients. Of 500 women, the pain was due to urologic, myofascial, musculoskeletal, gastrointestinal, or psychologic causes in 30%, rather than to disorders of the reproductive organs. Laparoscopy would be inappropriate in these patients. By providing women with appropriate therapy of nongynecologic pain, those whose pain is due to gynecologic sources can be treated more appropriately. In approximately 70% of these latter patients, endometriosis is the primary finding. A paradigm for the diagnosis and the cost-effective treatment of women with chronic pelvic pain of gynecologic cause was developed.