Improving chronic pelvic pain diagnosis; the role of clinical assessment and symptom evaluation

Abstract

Introduction: Chronic pelvic pain (CPP) is primarily caused by several problems such as endometriosis, adhesions, irritable bowel syndrome (IBS), infection, interstitial cystitis, psychological issues. There is an estimation that fifty percent of CPP cases remain undiagnosed. Objectives: In the present study, we tried to improve the CPP diagnosis rate by clinical assessment and symptom evaluation using a standard questionnaire. Patients and Methods: We enrolled 70 women with CPP. Clinical examination was done using a questionnaire, namely pelvic pain assessment form from The International Pelvic Pain Society, to gather the data. Participants were requested for suitable paraclinical tests, and if they were suspected of non- gynaecological diseases, they were referred to related specialists. Patients were followed up 6 months after the visit and the final diagnosis was made at the end of follow-up. Results: Endometriosis was the most prevalent diagnosis (n=13). Around 11 patients with musculoskeletal symptoms, 22 patients with gastrointestinal symptoms and one patient with psychological symptoms were referred to appropriate clinics. Among women who were suspected for gynaecological, gastrointestinal, and musculoskeletal diseases, 76.1%, 76.2%, and 68.8% patients reported improvements in their symptoms. The kappa coefficient for gynaecological, gastrointestinal, and musculoskeletal symptoms were estimated 0.65, 0.78, and 0.77, respectively. The accuracy of gynaecological, gastrointestinal, and musculoskeletal symptoms was 0.82, 0.91, and 0.93, respectively. Conclusion: Physical examination findings and symptoms in the structure of pelvic pain assessment form can be valuable tools for diagnosis and treatment of CPP and will improve the diagnosis rate.