Chronic Pelvic Pain

Question 1

The importance of CPP in reproductive and sexual health.

Answer 1

Can lead to infertility and sexual dysfunction.

Question 2

CPP

Answer 2

Non-cyclical pain of 6 months
localising to the pelvis, aterior abdominal wall below umbilicus, lumbosacral back or buttocks
sufficient severity to cause functional disability or lead to medical care.

Question 3

five common causes

Answer 3

Endometriosi, adenomyosis
Pelvic adhesions (PID)
Pelvic varicosities Pelvic Congestion Syndrome)
Painful bladder
Irritable Bowel Syndrome

Question 4

Endometriosis

Answer 4

Endometrial tissue in the wrong place.
Retrograde period? goes up and forms endometrial tissue in fallopian tubes and ovaries

Thickens and thins with menstrual cycle, painful and eventually becomes inflamed.

Question 5

Discuss the symptoms of Endometriosis.

Answer 5

Severe Dysmenorrhoea: affects SES and quality of life.
Dyspareunia: IPV

Adhesions is a complication
Pain outside menstruation: adhesions (has nerves inside them)- infertility due uterine distortion.

Question 6

Management of Endometriosis in women not wanting to conceive.

Answer 6

Wanting to suppress cycle
Depot
COC- bleed every three months
Mirena very effective not available in the public sector

For Pain
Tramedol
Paracetamol
Ibuprofen

Question 7

Management of Endometriosis in women wanting to conceive.

Answer 7

Cyclical Provera and COC contraceptives (short term)
Pain

Question 8

Pathogenesis of Chronic PID.

Answer 8

End result of acute
Inflammatory response in which adhesions are formed from pathogens and pus.
frozen uterus

Question 9

Symptoms of Chronic PID.

Answer 9

Pelvic pain is not cyclical
does not respond to analgesia.
no bladder and bowel symptoms.