Chronic Pelvic Pain

Chronic Pelvic Pain is a not uncommon complaint of patients attending our outpatient clinic. When there are no pelvic masses, but definite pelvic tenderness, we consider them to have pelvic infection and treat them with a course of a combination of Doxycycline and metronidazole. If they get well with that, we counsel them about prevention of such infections and advise them to follow up in case there is a recurrence of the symptoms. If the symptoms persist, we offer them a course of another antibiotic or a laparoscopy to find out the cause of the pain and treat it appropriately. If they opt for another antibiotic, we give them amoxycillin and clavalunate combination. If that fails to cure them, we perform a laparoscopy. In about 60% cases it turns out to be pelvic infection. If there is any fluid in the pelvis, we aspirate it and perform microbiologic studies on it. If there is no fluid, we wash the pelvic peritoneum with normal saline, aspirate it and perform microbiologic studies on it. Based on the report, we give them appropriate antibiotic therapy. In 35% cases it turns out to be pelvic endometriosis in the form of scattered lesions. We cauterize the lesions with bipolar electrocautery. That cures their symptoms. If they are infertile, we treat any other factors responsible for the infertility too. About 70% of them conceive with this treatment. We do not find any cause of chronic pelvic pain in 5% patients. We get psychiatric consultation for suspected somatoform pain in these patients, and they do well with that.