5 Chronic pelvic pain: aetiology and therapy Ying Cheong * MD, MRCOG Specialist Registrar, Subspecialist Trainee in Reproductive Medicine and Surgery School of Medicine and Biomedical Sciences, Academic Unit of Reproductive & Developmental Medicine, Level 4, Jessop Wing, Tree Root Walk, Sheffield S10 2SF, UK R. William Stones MD, FRCOG Senior Lecturer in Obstetrics and Gynaecology University of Southampton, Level F(815), Princess Anne Hospital, Southampton SO16 5YA, UK Chronic pelvic pain (CPP) is a common condition in women and rates of consultation for CPP in general practice are similar to those for asthma and migraine. US and UK population-based stud- ies, together with data from UK hospital settings demonstrate a substantial impact of CPP on health-related quality of life. In this review, we will examine the current evidence on the aetiol- ogy and management of CPP, focussing on the randomised controlled trials (RCTs) that are avail- able to date. CPP is a heterogeneous condition and causation is often unclear. There are associations with specific pathological processes but a barrier to understanding is that many studies have data that are not comparable. In the community setting, as many as 60% of women with CPP have not received a specific diagnosis and up to 20% have not undergone any investigation. The factor most commonly associated with CPP in the community is irritable bowel syndrome, although in a tertiary setting with laparoscopy, pathology associated with CPP in ascending order of fre- quency is endometriosis (33%), adhesions (24%) and ‘no pathology’ (35%). Current RCTevidence provides some support for the use of ultrasound scanning as an aid to counselling and reassurance, progestogen (medroxyprogesterone acetate) or goserelin for pel- vic congestion and a multidisciplinary approach to assessment and treatment. Adhesiolysis is not shown to be of benefit other than in women with extensive adhesions. While studied in relation to dysmenorrhoea rather than CPP, the short term results for presacral neurectomy (PSN) and laparoscopic utero-sacral nerve ablation (LUNA) seem to be similar, although PSN has better results in the long term. Selective serotonin reuptake inhibitor (SSRI) antidepressants have not been shown to be of benefit in CPP. Most of these conclusions are based on the outcome of single randomised trials and therefore need replication. * Corresponding author. E-mail address: yingcheong@hotmail.com (Y. Cheong). 1521-6934/$ - see front matter ª 2006 Elsevier Ltd. All rights reserved. Best Practice & Research Clinical Obstetrics and Gynaecology Vol. 20, No. 5, pp. 695e711, 2006 doi:10.1016/j.bpobgyn.2006.04.004 available online at http://www.sciencedirect.com