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Pelvic pain is common and all too real

Three conditions are thought to cause most cases of this little-discussed and undertreated disorder.

By Susan J. Landers, amednews staff. June 27, 2005.

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Washington -- Chronic pelvic pain is widespread, devastating and costly, plus poorly understood by physicians, said John M. Gibbons Jr., MD, past president of the American College of Obstetricians and Gynecologists.

It is also a disorder that inspires shame and isolation for women, said Christin Veasley, director of research and professional programs with the National Vulvodynia Assn. They are often accused of exaggerating or even imagining the pain, she said. It took eight years for Veasley to find a successful treatment for her pain.

It doesn't have to be that way, Dr. Gibbons said at a June 9 Capitol Hill briefing presented by the Society for Women's Health Research.

Among the suspected causes of the pain are uterine fibroids, pelvic endometriosis and vulvodynia, said Dr. Gibbons. Uterine fibroids, for example, are estimated to be present in more than 75% of women, said Dr. Gibbons. While they often cause no symptoms, fibroids have been associated with pelvic pain and pressure, pain during intercourse, heavy periods, infertility, miscarriages and preterm labor.

Fibroids can be treated medically with injections of a gonadotropin-releasing hormone, or GnRH, agonist -- which can only be used for six to nine months -- or with a daily mifepristone, or RU-486, tablet.

Surgical options include either a full hysterectomy or laparoscopic surgery to target the fibroids; or newer techniques such as uterine artery embolization that targets the fibroids' blood supply or MRI-guided focused ultrasound.