Chronic pain syndromes of gynecologic origin.

Women seek gynecologic medical attention for 2 main reasons--abnormal bleeding and pelvic pain. Gynecologists are often more comfortable with the diagnosis and management of abnormal bleeding than with the diagnosis and management of pelvic pain. One reason is that chronic pelvic pain can result from a variety of abdominal and pelvic causes, including endometriosis, pelvic inflammatory disease, adhesions and urogenital causes, such as vulvodynia, and from bladder complaints, including overactive bladder, urinary tract infection and interstitial cystitis (IC). The symptoms of IC--chronic pelvic pain with urinary urgency, frequency and nocturia--are all too frequently attributed to these other causes of chronic pelvic pain, in large part because gynecologists rarely consider the bladder as a source of pelvic pain. In addition, IC can masquerade as, and coexist with, other causes of pelvic pain, particularly endometriosis. Early diagnosis and treatment of IC can reduce the occurrence of unnecessary procedures and treatments and can improve the patient's prognosis and quality of life. Bladder-origin pelvic pain should be considered in all women who present with these symptoms.