Medical management of chronic pelvic pain

Appropriate medical management of chronic pelvic pain depends on careful assessment from a medical diagnostic perspective and on obtaining a full appreciation of the patient's understanding of her problem and therapeutic objectives. In particular, it is essential to obtain a good insight into aspirations for fertility and the relative importance to each individual of symptom control versus ability to return to normal function despite ongoing pain. The medical assessment needs to adequately capture bowel and bladder symptoms and seek evidence for neuropathic features. Medication strategies include optimisation of the analgesic regimen, use of agents for neuropathic pain, modulation of hormonal factors with the oral contraceptive pill, progestogens or gonadotrophin-releasing hormone (GnRH) agonists, and utilisation of physical therapies such as pelvic floor relaxation guided by a physiotherapist. Cognitive behavioural approaches can mitigate negative psychological propensities, such as catastrophising or fear, and enable activation of the patient's own coping resources.