There are two kinds of pain. Acute pain typically occurs with an injury, illness or infection. A warning signal that something is wrong, it lasts only as long as it takes for the person to recover. In contrast, chronic pain lasts long after recovery from the initial injury or infection or is associated with a chronic disorder or underlying condition.
Among women with -CPP, four out of five (80 percent) are diagnosed with pelvic disease or disorder. The most common is endometriosis, in which pieces of the lining of the uterus attach to other organs or structures within the abdomen, and grow outside the uterus. In three major studies done since 1989, 71 to 83 percent of patients with chronic pelvic pain had endometriosis, either alone or in combination with one or more other disorders. Two of those disorders are adhesions (scar tissue resulting from previous abdominal or pelvic surgery) and fibroids (clumps of tissue that grow inside, in the wall of, or on the surface of the uterus). One study that used a laparoscope to examine 141 pelvic pain patients, found that 12.7 percent had endometriosis alone, 9.2 percent had fibroids alone, and 8.5 percent had adhesions alone; most patients had a combination of these or other disorders. (A laparoscope is a long, thin telescope-like instrument that is inserted through a woman's belly button and allows a surgeon to view abdominal organs.)
Other causes of and contributors to pelvic pain include but are not limited to pelvic infections and diseases of the urinary tract or bowel as well as hernias, slipped discs and psychological problems. (See the Diagnosis section at this Web site for a more complete discussion of all causes.)
Despite the number of causes, 20 percent of women with chronic pelvic pain have no diagnosable condition that even partly explains their pain. These are often the women who make the rounds of various specialists seeking relief, only to be told the pain is "all in their heads" or subjected to multiple tests and even surgery unnecessarily.
Simply put, there is no simple answer to the question, "What causes chronic pelvic pain?" and no "typical patient." Still, a woman with pelvic pain is more likely to:
- have been sexually or physically abused
- be married rather than single or divorced
- be in her early 30s
- be white rather than from another racial group
- have a history of drug and alcohol abuse
- have sexual dysfunction
- have a mother or sister with chronic pelvic pain
- have history of PID
- have had abdominal or pelvic surgery or radiation therapy
- have previous or current diagnosis of depression
- have a structural abnormality of the uterus, cervix or vagina.
Some of these, like family history, surgery and PID, are obvious risk factors; others (drug abuse, depression) may be risk factors or result from having chronic pain.