Chronic pelvic pain.

Chronic pelvic pain is one of the most challenging gynecologic problems seen in primary care practice. Important causes of this problem include endometriosis, pelvic adhesions, chronic pelvic inflammatory disease, and the syndrome of chronic pelvic pain without obvious pathology. The diagnostic approach to chronic pelvic pain begins with a careful medical history and physical examination in conjunction with a comprehensive psychosocial assessment. Laboratory evaluation may include pelvic ultrasonography, psychometric testing, and diagnostic laparoscopy. Optimal management of these patients may require a multidisciplinary approach, integrating chronic pain management techniques with specific therapy.