Medical management of chronic pelvic pain: the evidence

Chronic pelvic pain (CPP) forms a significant number of referrals both in primary care and to gynaecology clinics. Much has been written and reported on the subject, however, it remains a poorly understood and managed condition. CPP is defined as recurrent or constant pain in the lower abdominal region that has lasted at least 6 months. A specialist in the field encompassed within a multidisciplinary setting should ideally manage CPP. The causes of CPP can be not only of a gynaecological nature, but also span other branches of medicine including urology, gastroenterology, rheumatology, genitourinary medicine and psychiatry. Investigations are often unrewarding in eliciting a cause for particular symptomatology, which highlights the difficulty in treating these patients. Most studies have been directed towards the major gynaecological causes of CPP including pelvic venous congestion, endometriosis, and pelvic inflammatory disease (PID). However, these have been limited and evaluated treatments are confined to small sample sizes. This review aims to provide evidence-based medical management of the main causes of CPP.