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Chronic Pelvic Pain, Initial Management (Green-top Guideline No. 41)

Published: 23/05/2012

Update February 2017: Please note, following a review of the guidelines in December 2016, minor amendments have been made. The version available here is the most up to date. The date on the guideline has not been changed since no amendments were made to the content.

Update December 2014: New evidence and guidance in this field were reviewed in 2014 and it was decided that revision of this guideline would be deferred to a later date. The version available on the website and app will remain valid until replaced.

This is the second edition of this guideline. The first edition was published in 2005 under the same title.

Chronic pelvic pain can be defined as intermittent or constant pain in the lower abdomen or pelvis of a woman of at least 6 months in duration, not occurring exclusively with menstruation or intercourse and not associated with pregnancy. It is a symptom not a diagnosis. Chronic pelvic pain presents in primary care as frequently as migraine or low-back pain and may significantly impact on a woman’s ability to function. Living with any chronic pain carries a heavy economic and social burden.

Aiming for accurate diagnosis and effective management from the first presentation may help to reduce the disruption of the woman’s life and may avoid an endless succession of referrals, investigations and operations. This guideline provides an evidence-based framework for the initial assessment of women with chronic pelvic pain. It is intended for the general gynaecologist but may be of use to the general practitioner in deciding when to refer and to whom.