Chronic Pelvic Pain (CPP) is a common symptom in women, but one that is often difficult for patients to discuss. Nevertheless it comprises 10% of all gynaecological outpatient visits. The term "chronic" refers to the fact that the pain has been present for more than 3-6 months.
The pain may be constant or at certain times of the menstrual cycle. It may be focused, say, on the left or the right, or it may be throughout the pelvis. It may radiate from the pelvis to the back or to the legs.
As a symptom it may affect many other aspects of the sufferer's life. As well as problems with intercourse that can make this problem difficult to talk about, it can cause lethargy, depression, and anxiety and can affect performance at work. As well as the symptoms there is the worry about what might be the cause. Whilst there are many causes of pelvic pain, there are two gynaecological causes that are common.

1. Adhesions are formed as part of the body's natural healing process. When tissues are damaged in some way, eg infection, surgery, the body tries to close the area off by causing tissues to stick together. The tissues that stick together mostly do not present a problem. However, occasionally, there is tension on sensitive organs. A woman's reproductive organs are very sensitive so adhesions may cause pain.
   
   
2. Endometriosis is a condition where the lining of the womb, that part that is discarded each month with a menstrual period, grows in another site (usually elsewhere in the pelvis). When the hormonal message for a period reaches the endometrium, it and the misplaced endometriosis is discarded. The resulting blood loss, though small in volume can be irritant if it is in the wrong place as a result of endometriosis. This can cause CPP, though it may be painless. Some have assessed the incidence of endometriosis in the reproductive years as being 10%.

Diagnosis and care
Whilst much pelvic pain is gynaecological, not all falls into that category. The first step is to determine the site of origin of the pain. A simple outpatient consultation is the first step. Mr Shaw will talk with you at length to determine the associations with the pain. A clinical examination will assess the area of greatest tenderness and the site of the pain may then be mapped out. The subsequent investigation will be determined by the findings but may involve a scan or a laparoscopy.
Ongoing care may require a multidisciplinary approach; counselling, complementary therapies and other disciplines might be recruited as necessary.