Epidemiology of chronic pelvic and vulvalperineal pain in women

Population data on pain prevalence in women are available. A US-based telephone survey interviewed respondents aged 18-50 years [21]; 17,927 households were contacted, 5325 women agreed to participate, and of these 925 reported pelvic pain of at least 6 months' duration, including pain within the past 3 months. Having excluded those pregnant or post-menopausal and those with only cycle-related pain, 773/5263 (14.7%) were identified as suffering from chronic pelvic pain. A British population survey used a postal sample of 2016 women randomly selected from the Oxfordshire Health Authority register of 141,400 women aged 18-49 years [22]. Chronic pelvic pain was defined as recurrent pain of at least

6 months' duration, unrelated to periods, intercourse or pregnancy. For the survey, a "case" was defined as a woman with chronic pelvic pain in the previous 3 months, and on this basis the prevalence was 483/2016 (24.0%). There were significant associations between chronic pelvic pain and the specific symptoms of dysmenorrhea and dyspareunia.

In the setting of UK primary care consultations, data from 284,162 women aged 12-70 years who had a general practice contact in 1991 were analyzed to identify subsequent contacts over the following 5 years [23]. The monthly prevalence rate was 21.5/1000 and the monthly incidence rate was 1.58/1000. The authors highlighted the burden of disease represented by these data, pointing out the comparability with migraine, back pain and asthma in primary care. Older women had higher monthly prevalence rates: for example, the rate was 18.2/1000 in the 15-20 year age group and 27.6/1000 in women over 60 years of age. This association was thought to be due to persistence of symptoms in older women, the median duration of symptoms being 13.7 months in 13-20 year olds and 20.2 months in women over 60 years [24].

The presence of symptoms does not necessarily reflect healthcare seeking. This was highlighted in the UK population survey described above: of 483 women with chronic pelvic pain, 195 (40.4%) had not sought a medical consultation, 127 (26.3%) reported a past consultation and 139 (28.8%) reported a recent consultation for pain [25]. The US telephone survey discussed above also drew attention to the large numbers of women with symptoms who do not seek medical attention. Seventy-five percent of this sample had not seen a healthcare provider in the previous 3 months.

With regard to vulval pain, the single available population-based sample survey was undertaken in Boston, USA [26]. Census records were used to sample 4915 women aged 18-64 years using a self-administered questionnaire. Approximately 16% of respondents reported histories of chronic burning, knife-like pain or pain on contact that lasted for at least 3 months or longer. These symptoms were present in nearly 7% at the time of the survey. As with the pelvic pain surveys discussed above, a substantial proportion of women reported that they had not sought treatment. Of those who did seek healthcare,

60% saw three or more doctors but a positive diagnosis was frequently absent.

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