Stump the Gynecologist: Differential Diagnosis of Chronic Pelvic Pain. Jennifer K. McDonald DO F.A.C.O.G. October 10, 2008. ACOG Definition.
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Stump the Gynecologist: Differential Diagnosis of Chronic Pelvic Pain
Jennifer K. McDonald DO F.A.C.O.G.
October 10, 2008
“Non-cyclic pain of 6 or more months duration that localizes to the anatomic pelvis, abdominal wall at or below the umbilicus, lumbosacral back or the buttocks and is of sufficient severity to cause functional disability or lead to medical care.”
15% of American women
61% of CPP will have no definitive diagnosis !!
Pain is symptom of underlying tissue damage
Pain itself becomes the disease
Gynecologic - extra-uterine
Gynecologic - uterine
UterusT12lower abdominal wall
VaginaL1skin over groin
Low back pain
The many faces of endometriosis
69% posterior & anterior
cul de sac
47% posterior broad ligament
36% uterosacral ligaments
6% fallopian tubes
4% sigmoid colon
IC is a chronic inflammatory condition of the bladder characterized by irritable voiding symptoms of urgency and frequency in the absence of objective evidence of another disease that could cause the symptoms
Pathogenesis of IC:Defective Urothelial Barrier
IC is Typically Diagnosed Late in Disease Continuum
Average Time Between Initial Development of Symptoms and Diagnosis is 5 Years
See at least
and reduced QOL
Diagnosis of IC
IC Concurrent with Endometriosis
Diagnosis of Patients With CPP byCystoscopy and Hydrodistention & Laparoscopy1
Clinicians should consider the bladder to be the source of CPP, even when endometriosis is present
11 or more TP sensitivity of 88% and specificity of 81%
The patient with CPP needs a multidisciplinary approach … are you ready?