Pelvic pain is a common syndrome, particularly in women, 15-20% of whom will experience it sometime in their life. It is reported throughout women’s reproductive life as being either cyclical (tied to the menstrual period), non-cyclical, or both. When pain persists beyond 6 months, it is considered chronic pelvic pain.
Chronic pelvic pain has a large differential diagnosis that includes both gynecologic and non-gynecologic diseases. The most prevalent gynecologic disease associated with chronic pelvic pain is endometriosis. Endometriosis is the presence of uterine lining tissue—endometrium—growing outside the confines of the uterus. It is diagnosed by the microscopic finding of endometrium tissue elements, glands, and stroma, in a body cavity or surface outside the uterine cavity. The most common location for endometriosis is in the most gravity-dependent part of the pelvic, i.e., the areas between the rectum and vagina, the ovaries, the sidewall areas of the pelvis, and the area between the bladder and uterus. It can also exist (less commonly, but not rarely) in more distant tissues such as appendix, bowel, bladder, liver, diaphragm, and lung. It can also grow in surgical scar sites, such as after a cesarean section, laparoscopy, or hysterectomy.
Chronic pelvic pain medical expert witness specialties include gynecology and robotic gynecologic surgery.