Robert C. Reiter The University of Iowa College of Medicine
Chronic pelvic pain (CPP) may be defined as noncyclic abdominal and pelvic pain of at least 6 months' duration. This syndrome, and the many adverse psychosocial outcomes with which it is associated, represent a primary health concern of women. Inappropriate health care utilization, high rates of undiagnosed psychological morbidity, and protracted disability have been documented in several studies ( Walker, Katon, & Jemelka, 1991; Walling, O'Hara, et al., 1994).
The significance of CPP is readily appreciated. In one nonclinical sample of 651 women, the current prevalence rate of CPP was 12%, and the lifetime occurrence rate was 33% ( Walker et al., 1991). This syndrome has been estimated to account for approximately 15% of outpatient gynecological consultations and is responsible for one third of laparoscopies performed in the United States ( Reiter & Gambone, 1991).
In addition, CPP is listed as the indication for 12% to 16% of hysterectomies performed in the United States, accounting for approximately 80,000 procedures annually ( Dicker et al., 1982; Gambone, Lench, Slesinski , Reiter, & Moore, 1989). Despite its high use, there are no controlled trials evaluating the long-term effectiveness of hysterectomy for chronic pain. However, approximately 25% of women referred for evaluation of CPP have previously undergone hysterectomy without resolution of symptoms ( Slocumb, 1990).