Differential diagnosis

A. Endometriosis is the most common etiology of CPP in populations with a low prevalence of sexually transmitted infections. Endometriosis is found in up to 70 percent of patients with CPP.

B. Chronic pelvic inflammatory disease (PID) is one of the most common gynecologic conditions causing CPP in practices with a high prevalence of sexually transmitted diseases.

C. Mental-health issues. Somatization disorder, drug seeking behavior and narcotic dependency, physical and sexual abuse, and depression are commonly diagnosed in women with CPP.

D. Fibromyalgia. Women with fibromyalgia sometimes present with CPP. Two criteria must be present for diagnosing fibromyalgia: The patient reports pain in all four quadrants of the body, and detection of at least 11 separate areas (eg, knees, shoulders, elbows, neck) that are tender to physical pressure.

E. Irritable bowel syndrome (IBS) is a gastrointestinal syndrome characterized by chronic abdominal pain and altered bowel habits in the absence of any organic cause.

F. Interstitial cystitis is characterized by urinary urgency, bladder discomfort, and a sense of inadequate emptying of the bladder. Dyspareunia is often present. Cystoscopy is diagnostic.

Some Causes of Chronic Pelvic Pain by System

Gynecologic

Endometriosis Adenomyosis Leiomyomata Adhesions Ovarian cyst/mass Pelvic inflammatory disease

Endosalpingiosis Cervical stenosis Pelvic relaxation

Systemic diseases

Fibromyalgia Depression Somatization Substance abuse

Urologic

Interstitial cystitis Urethral disorders

Gastrointestinal

Irritable bowel Diverticulitis Inflammatory bowel disease

Constipation Hernia

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