Chronic pelvic pain (CPP) is defined as 

non‐cyclical pain lasting for more than 6

months, localized to the anatomical pelvis
and anterior abdominal wall, at or below the
umbilicus, or to lumbo‐sacral back and
buttocks of sufficient severity to cause
functional disability or lead to medical
intervention .
CPP is a broad term with varied presentations 
and has a significant impact on quality of life.
It may present as dysmenorrhoea,
dyspareunia, vulvodynia on‐specific pelvic
pain, musculoskeletal pain intestinal cramps
or dysuria. CPP is associated with
long‐standing mental health problems, with
reported increased rates of anxiety,
depression, somatic disorders disturbed
concentration and insomnia .
It is recognized that in England it can take 
several years for a patient’s persistent chronic
pain condition to be recognized and even
longer before management is provided in a
secondary care setting
chronic salpingitis 
Inflammatory, non‐infective: endometriosis, 
vulvodynia with
dermatosis 
Mechanical: uterine retroversion, adhesions 
Functional: pelvic congestion, irritable bowel 
syndrome pain.
Inflammatory, infective: 
Neuropathic: post‐surgical, dysaesthetic vulvodynia, 
vulval
vestibulodynia (‘vestibulitis’) 
Musculoskeletal: pelvic floor myalgia, abdominal and 
pelvic
trigger points, postural muscle 
History should differentiate between 
gynecological and non gynecological pelvic
pain
Investigations depend on the diagnosis 
suggested by history and examination
1 RBS, Tsh, T3, T4 
2 Endocervical swab , chlamydia 
3 Pelvic ultrasound 
4 Laparascopy is useful in case where 
examination and imaging were inconclusive
Local examination of the perineum should be 
carried out after obtaining verbal consent and
in the presence of a chaperone. Vulval
erythema may suggest infection, whilst
thinning is suggestive of lichen sclerosus. In
cases of vulvar vestibulitis, there can be local
redness near the vestibular gland.
The uterus should be palpated for size, 
mobility and tenderness. Palpation of the
adnexa may reveal masses like
endometriomas or there can be tenderness in
the adnexa due to pelvic congestion
During vaginal examination tenderness on 
palpation of the pelvic floor muscles could
suggest myofasciitis of the pelvic
musculature syndrome
According to the cause 
1, Medical therapy 
Medroxyprogesteroneacetate , not so useful 

GnRH analogue (goserelin) 

Antidepressant has better efficacy 
Lparascopic uterosacral and adhesionolysis 
nerve ablasion ( luna) , should not be
performed
Transvenous occlusion of the ovarian and 
internal iliac veins can be successful and lead
to improvement in pelvic pain , frequency and
dysmenorrhea and dyspareunia lasting for 5
years