AS THE name suggests, CPP is long-term pain in the lower abdomen. There is a range of possible causes, including endometriosis, and pelvic inflammatory disease (PID).

Diagnosis: Symptoms can include abnormal vaginal discharge; a swab will reveal the type of infection responsible. Where there is no discharge, an ultrasound scan may help; however, a clearer picture can be obtained through a diagnostic laparoscopy (a camera is inserted into the abdomen to check for endemetriosis, scar tissue or internal adhesions that are causing pain) - in highly specialised centres this can be done under local anaesthetic in hospital. A small incision is made in the navel and a telescope, attached to a monitor, is inserted to help to identify any abnormalities.

Treatment: Infections, such as PID, are usually treated with antibiotics. There is a variety of treatments for conditions such as endometrosis. However, for half the women who undergo a diagnostic laparoscopy, results reveal no gynaecological cause for the pain. Some patients might be referred to a pain management clinic where they can be offered a combination of painkillers, electro-nerve stimulation, physiotherapy and psychotherapy to enable them to cope better with CPP.

Incidence: CPP accounts for 20 per cent of all gynaecological outpatient visits. It is as common as asthma or migraines in primary healthcare.

New research/developments: A procedure known as LUNA (laparoscopic utero-sacral nerve ablation) may relieve CPP by removing nerves at the back of the womb — these nerves carry pain messages to the brain. Although not regarded as a cure, LUNA could provide symptom relief in cases where there is no identifiable source of pain. After promising pilot studies, researchers at Birmingham Women’s Hospital led by Khalid Khan, consultant obstetrician gynaecologist, have recruited more than 300 of a target of 450 patients for a fully randomised multi-centre trial and expect to report in three to four years’ time.

Links:

www.wellbeing.org.uk
The Health Research Charity for Women and Babies, 020-7772 6400

www.luna.bham.ac.uk

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