Chronic Female Pelvic Pain

Surgery

Surgery may be used in the diagnosis or treatment of chronic pelvic pain. It is most likely to be effective when it is performed for a specific condition, such as fibroids or endometriosis.

There is no evidence that surgical removal of the reproductive organs relieves chronic pelvic pain. It can even make the pain worse.⁵ When surgery, such as hysterectomy or cutting of specific pelvic-area nerves, is done for pain with no known cause, there is a risk of persistent pain or pain that is worse after surgery as well as surgery-related side effects.

Surgery Choices

Either laparoscopic surgery through a small incision or laparotomy through a larger abdominal incision can be used for procedures to treat pelvic pain.

• Hysterectomy, the surgical removal of the uterus, is sometimes used as a last-resort treatment for chronic, severe pelvic pain. Depending on the cause, hysterectomy may relieve pain for some women.
• Studies have shown that surgery to remove scar tissue adhesions from previous surgery or from pelvic inflammatory disease does not relieve pain unless the adhesions are severe (referred to as stage IV adhesions).²

What To Think About

Laparoscopy to diagnose chronic pelvic pain may be done before treatment with medications (other than birth control pills) or surgery. Sites of endometriosis (implants) or scar tissue (adhesions) may be removed or destroyed during the laparoscopy.⁶

Hysterectomy is only a good treatment choice for chronic pelvic pain when a documented disease or surgically correctable condition of the pelvic organs is present. When hysterectomy is performed solely for relief of pelvic pain, the results may be disappointing.

Surgery may lead to complications that cause added pain, discomfort, or other problems such as infection or scar tissue.

Symptoms caused by chronic pelvic pain often go away without treatment when menopause occurs and hormone fluctuations settle down. Controlling symptoms with home treatment or medications until menopause may be an option. Symptoms of chronic pelvic pain may return if you decide to use hormone replacement therapy for perimenopausal symptoms. Discuss your options with your health professional if you are nearing menopause.

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Author:	Kathe Gallagher, MSW	Last Updated: January 30, 2007
Medical Review:	Renée M. Crichlow, MD - Family Medicine Kirtly Jones, MD - Obstetrics and Gynecology
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