Chronic pelvic pain (CPP) is a frustrating, challenging condition for patients, health care providers, and caregivers. CPP is defined as "noncyclic pain lasting 6 months or longer, localized to the anatomic pelvis, anterior abdominal wall at or below the umbilicus, the lumbosacral back, or the buttocks, and is of sufficient severity to cause functional disability or lead to medical care." CPP is noted in 15 to 20 of women between the ages of 18 and 50 years who have pain for more than 1 year in duration. Ten percent of office consults, 30 to 40 of laparoscopies, and 15 of all hysterectomies are attributed to CPP. The possible causes of CPP are vast but can be broken down into categories that include gynecologic, gastrointestinal, urologic, muscu-loskeletal, and infectious. Many women suffer from chronic, neuropathic pain and most have some degree of psychological overlay, which can be a primary etiology or a secondary component of the problem. In a community-based study by Howard in 1993, 1318 patients with CPP underwent laparoscopy, and no pathology was identified in 39 of patients. Endometriosis and adhesions were the most common specific causes, identified in 28 and 25 of patients, respectively.
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