Role of Hysterectomy in the Treatment of Chronic Pelvic Pain

Obstetrics and Gynecology, 05/03/2011

Lamvu G – To maximize the chances of pain resolution, all women with chronic pelvic pain should undergo a full evaluation of the urologic, gastroenterologic, neurologic, and musculoskeletal organ systems before surgery to exclude nonreproductive causes of pain.

  • The multifactorial nature of chronic pelvic pain makes it difficult to evaluate and treat.
  • Therapies vary and may include surgical interventions such as hysterectomy.
  • Although hysterectomy is an accepted treatment for chronic pelvic pain, it has important limitations that need to be discussed with the patient before surgery.
  • Women can expect improvement in pain levels and function from their preoperative baseline.
  • However, studies show that in the absence of any obvious pathology, 21–40% of women having a hysterectomy for chronic pelvic pain may continue to experience pain after the surgery and 5% may have new onset of pain.
  • Women may experience improvements in mental health, physical function, social function, and dyspareunia; however, sexual frequency is not likely to change.
  • Comorbidities such as preoperative depression may lower the chances of pain resolution after hysterectomy.
  • 14% of women report having results worse than expected and almost 26% may have a slower recovery than expected.

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