Pelvic disease, psychological morbidity, and a history of abuse are the factors most strongly associated with chronic pelvic pain in women, according to a metaanalysis including data on more than 90,000 patients.
Dr. Pallavi Latthe and colleagues at the University of Birmingham (England) evaluated 122 studies that examined dysmenorrhea, dyspareunia, and noncyclical pelvic pain, including recurrent pelvic pain. The reports included were published in six languages and were extracted from several large databases; a total of 94,927 women were assessed.
Studies were chosen based on inclusion of relevant clinical and statistical terms, as well as quality of the research design (BMJ 2006;332:749–55).
Patient characteristics associated with dysmenorrhea were being at least 30 years of age, having a body mass index of less than 20 kg/m
The factors associated with decreased risk were use of oral contraceptives, being married, having children, exercising, and including fish in the diet.
For dyspareunia, associated factors were having undergone female genital mutilation, having clinically suspected pelvic inflammatory disease, and being peri- or postmenopausal. Depression, anxiety, and history of sexual assault were more common in women with dyspareunia.
Those factors most strongly associated with noncyclical pelvic pain were childhood or adult physical, sexual, or other abuse; miscarriage; longer menstrual flow; presence of endometriosis; clinically suspected pelvic inflammatory disease; C-section scar; pelvic adhesions; anxiety; depression; and somatization.
The investigators concluded that “strong and consistent associations” existed “between chronic pelvic pain and presence of pelvic pathology, history of abuse, and coexistent psychological morbidity … [providing] potential targets for new therapeutic strategies for treating women with this disabling condition, for which current treatment options provide little relief.”