Evaluation and Treatment of Chronic Pelvic Pain

Chronic pelvic pain (CPP) is a complex and often debilitating condition that affects 15-26% of women worldwide. It is defined as pain perceived to originate from pelvic organs or structures that typically lasts longer than 6 months and is often associated with negative cognitive, behavioral, sexual, and emotional consequences. Chronic pelvic pain is not a single disease but rather a symptom with many potential causes, with most patients having multiple contributing conditions. This article provides an overview of the evaluation and management of CPP for obstetrician-gynecologists. We recommend an organ system-based approach to diagnosis, recognizing that any combination of gynecologic, gastrointestinal, musculoskeletal, urologic, neurologic, and vascular sources is a possible cause. Effective management integrates behavioral, pharmacologic, and surgical strategies tailored to the suspected pain mechanisms in each patient. Educating patients about pain physiology, including the interaction between peripheral pathology and central pain amplification, is essential. Although CPP is not always curable, patients can experience significant and meaningful improvement in pain, function, and quality of life through long-term interdisciplinary support. Establishing a strong therapeutic relationship, validating patients' experiences, and empowering patients to take an active role in their care are central to effective management. Shared decision making, collaborative goal setting, and establishing clear expectations support sustained engagement and functional improvement.