Thinking outside the pelvis: a modern approach to chronic pelvic pain

Chronic pelvic pain is a major public health problem that impacts all areas of a woman's life. The diagnosis is frequently difficult and delayed with women often presenting to a variety of specialties and undergoing multiple investigations before a diagnosis is reached. Aetiology is frequently multifactorial with both precipitating and perpetuating factors. An understanding of the role of the nervous system in chronic pain is essential both to plan appropriate management and to provide the patient with an acceptable explanation of her symptoms. Optimal management is within a multidisciplinary team who can fully address the range of factors that may maintain pelvic pain. Focussing solely on the pelvic organs and associated pathologies is likely to leave the majority of women with persistent symptoms.