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Gynaecology
Chronic pelvic pain
Non-cyclical pain of 6+ months duration, often multifactorial.
1. Clinical overview & diagnosis
Chronic pelvic pain is non-cyclical pain of 6+ months duration below the umbilicus, often multifactorial (gynaecological, musculoskeletal, urological, gastrointestinal, and central sensitisation components). Diagnosis requires a structured, biopsychosocial approach.
Red flags for urgent referral
- • New pain after menopause
- • Unexplained weight loss
- • Rectal bleeding
- • Haematuria
- • Pelvic mass
2. Patient diagnostic pathway
- 1History — Pain characteristics, cyclicity, associated bladder/bowel/sexual symptoms, psychosocial factors, prior trauma.
- 2Examination — Abdominal, pelvic, and where relevant musculoskeletal examination of the pelvic floor.
- 3Investigations — Targeted to the suspected cause: pelvic ultrasound, urinalysis/MSU, STI screening, consider laparoscopy where endometriosis is suspected.
3. Treatment & management plan
- • Address contributing components.
- • Consider a trial of hormonal suppression if a cyclical/endometriosis component is suspected.
- • Pelvic floor physiotherapy for myofascial pain.
- • Multimodal analgesia and management of central sensitisation.
- • Address psychological comorbidity early.
4. Patient pathway & referral
When & where to refer
- • Multidisciplinary pelvic pain service where available
- • Gynaecology for suspected endometriosis
- • Pain specialists for refractory central pain
Patient education & resources
Clinical decision support only. Not a substitute for independent clinical judgement. HerPath informs, it does not replace the treating practitioner.