Cited by 1,074Endometriosis Research and TreatmentMenstrual Health and DisordersMusculoskeletal pain and rehabilitation

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Chronic Pelvic Pain: Prevalence, Health-Related Quality of Life, and Economic Correlates

Mathias, S·1996·Obstetrics & Gynecology

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Abstract

OBJECTIVE: To determine the prevalence of chronic pelvic pain in U.S. women aged 18-50 years, and to examine its association with health-related quality of life, work productivity, and health care utilization. METHODS: In April and May 1994, the Gallup Organization telephoned 17,927 U.S. households to identify women aged 18-50 years who experienced chronic pelvic pain, ie, of at least 6 months' duration. Those who reported chronic pelvic pain were surveyed on severity, frequency, and diagnosis; quality of life; work loss and productivity; and health care utilization. RESULTS: Among 5263 eligible women who agreed to participate, 773 (14.7%) reported chronic pelvic pain within the past 3 months. Those who reported chronic pelvic pain had significantly lower mean scores for general health than those who did not (70.5 versus 78.8,P<.05), and 61% of those with chronic pelvic pain reported that the etiology was unknown. Women diagnosed with endometriosis reported the most health distress, pain during or after intercourse, and interference with activities because of pain. Estimated direct medical costs for outpatient visits for chronic pelvic pain for the U.S population of women aged 18-50 years are $881.5 million per year. Among 548 employed respondents, 15% reported time lost from paid work and 45% reported reduced work productivity. CONCLUSION: Frequently, the cause of chronic pain is undiagnosed, although it affects approximately one in seven U.S. women. Increased awareness of its cost and impact on quality of life should promote increased medical attention to this problem.

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“Prevalence rates range from 4e15% depending on the population studied.(2,3) Several previous studies have suggested that mode of delivery may have an impact on the development of pelvic pain.”
Comparative Measurement of Pelvic Floor Pain Sensitivity in Chronic Pelvic Pain
Tu, F. F., Fitzgerald, C. M., Kuiken, T., Farrell, T. R., & Norman, H. R. (2007) · Obstetrics and Gynecology · doi:10.1097/01.aog.0000289228.23903.cc · Cited by 42
“23 Menses 1 (8) 2 (7) Follicular 3 (23) 5 (17) Luteal 7 (54) 12 (41) Menopausal 0 8 (28) Hysterectomy 2 (15) 2 (7) Missing 1 (8) 1 (3)”
Is chronic pelvic pain a comfortable diagnosis for primary care practitioners: a qualitative study
McGowan, L., Escott, D., Luker, K. A., Creed, F. H., & Chew-Graham, C. A. (2010) · BMC Family Practice · doi:10.1186/1471-2296-11-7 · Cited by 42
“Furthermore, community surveys report between 15 and 24 % of women aged 18 to 50 years old report experiencing CPP within the last three months [3,4].”
Management of Dyspareunia and Associated Levator Ani Muscle Overactivity
Fisher, K. A. (2007) · Physical Therapy · doi:10.2522/ptj.20060168 · Cited by 42
Irritable bowel syndrome and chronic pelvic pain: A singular or two different clinical syndrome?
Matheis, A. (2007) · World Journal of Gastroenterology · doi:10.3748/wjg.v13.i25.3446 · Cited by 40
Changes in urinary bladder smooth muscle function in response to colonic inflammation
Noronha, R. F. X., Akbarali, H. I., Malykhina, A. P., Foreman, R. D., & Meerveld, B. G. (2007) · American Journal of Physiology-Renal Physiology · doi:10.1152/ajprenal.00311.2007 · Cited by 41
“CHRONIC PELVIC PAIN IS A COMMON condition affecting as many as 15% of women within the United States (14).”
Background
Chronic pelvic pain improvement: impact on quality of life and mood
Cagnacci, A., Vecchia, E. D., & Xholli, A. (2019) · Gynecological Endocrinology · doi:10.1080/09513590.2018.1540571 · Cited by 44
“Prevalence of CPP has been estimated to vary from 15 to 25% among women of fertile age [2, 3].”
Background
Cognitive behavioral therapy for the treatment of chronic pelvic pain
Urits, I., Callan, J., Moore, W., Fuller, M. C., Renschler, J. S., Fisher, P., Jung, J. W., Hasoon, J. J., Eskander, J. P., Kaye, A. D., et al. (2020) · Best practice & research. Clinical anaesthesiology · doi:10.1016/j.bpa.2020.08.001 · Cited by 50
Quality of life and associated factors in Brazilian women with chronic pelvic pain
Da Luz, R. A., de Deus, J. M., & Conde, D. M. (2018) · Journal of Pain Research · doi:10.2147/jpr.s168402 · Cited by 40
“15,29 Loss of work time, reduced work capacity, and a greater likelihood of sleep disorders and fatigue have also been reported, 4,5,12,13 as well as impaired mobility in women with CPP. 4,5 Those data confirm the pres-ent findings, since aspects related to work, sleep, fatigue, and mobility, are…”
Influential
Validação de versão para o português de questionário sobre qualidade de vida para mulher com endometriose (Endometriosis Health Profile Questionnaire - EHP-30)
Mengarda, C. V., Passos, E. P., Picon, P., Costa, A. F., & Picon, P. D. (2008) · Revista Brasileira de Ginecologia e Obstetrícia · doi:10.1590/s0100-72032008000800003 · Cited by 38
Randomized Controlled Trial of Depot Leuprolide in Patients With Chronic Pelvic Pain and Clinically Suspected Endometriosis
LING, F. W. (1999) · Obstetrics & Gynecology · doi:10.1097/00006250-199901000-00012 · Cited by 223
Association Between Nociplastic Pain and Pain Severity and Impact in Women With Chronic Pelvic Pain
Till, S. R., Schrepf, A., Clauw, D. J., Harte, S. E., Williams, D. A., & As‐Sanie, S. (2023) · Journal of Pain · doi:10.1016/j.jpain.2023.03.004 · Cited by 44
Endometriosis, chronic pain, anxiety, and depression: A retrospective study among 12 million women
Kigloo, H. N., Itani, R., Montreuil, T. C., Feferkorn, I., Raina, J., Tulandi, T., Mansour, F., Krishnamurthy, S., & Suarthana, E. (2023) · Journal of Affective Disorders · doi:10.1016/j.jad.2023.11.034 · Cited by 45
Heavy menstrual bleeding and dysmenorrhea in adolescents: A systematic review of self‐management strategies, quality of life, and unmet needs
Roudbaneh, S. P., Marino, J. L., Riggs, E., Saber, A., Jayasinghe, Y., & Peate, M. (2024) · International Journal of Gynecology & Obstetrics · doi:10.1002/ijgo.15554 · Cited by 40
“75,76 Unmet needs among young women with DM and HMB must be identified and addressed.”
Potential impact of vaccination againstNeisseria meningitidisonNeisseria gonorrhoeaein the United States: Results from a decision-analysis model
Régnier, S. A., & Huels, J. (2014) · Human Vaccines & Immunotherapeutics · doi:10.4161/hv.36221 · Cited by 40
“The disutility from chronic pelvic pain was calculated from a survey of 17,927 households.(22) Disutilities due to PID and infertility were calculated using the input of experts from the Institute of Medicine(7) (see Supplemental Digital Content 2 for”
Method
Multivariate Genetic Analysis of Chronic Pelvic Pain and Associated Phenotypes
Zondervan, K. T., Cardon, L. R., Kennedy, S., Martin, N. G., & Treloar, S. A. (2005) · Behavior Genetics · doi:10.1007/s10519-004-1017-6 · Cited by 40
“7%) was lower than found in other population-based surveys (Mathias et al., 1996; Zondervan et al., 2001b), most likely due to a difference in case definition.”
BackgroundResultInfluential
Quality of life instruments in studies of chronic pelvic pain: a systematic review
Neelakantan, D., Omojole, F., Clark, T. J., Gupta, J., & Khan, K. S. (2004) · Journal of Obstetrics and Gynaecology · doi:10.1080/01443610400019138 · Cited by 40
“…from that affected by health or illness (Vercellini et al., 2002); two articles included supplemental patient comments (Rannestad et al., 2000; Stones et al., 2000); and three articles asked for a separate global rating for QoL (Mathias et al., 1996; Jones et al., 2001; Vercellini et al., 2002).”
Background
Gonadotropin-releasing hormone analogues for endometriosis
Veth, V. B., van de Kar, M. M., Duffy, J. M., van Wely, M., Mijatovic, V., & Maas, J. W. (2023) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd014788.pub2 · Cited by 39
The burden of Chronic Pelvic Pain (CPP): Costs and quality of life of women and men with CPP treated in outpatient referral centers
Hutton, D. W., Mustafa, A., Patil, S., Rathod, S., Shrikhande, G., Advincula, A. P., Drummond, J., Gregersen, P. K., Hall, J. F., Metz, C. N., et al. (2023) · PLoS ONE · doi:10.1371/journal.pone.0269828 · Cited by 38
“CPP patients with depression are prescribed opioids more often and at higher doses than non-depressed patients for example [38].”
Background
Ovarian vein incompetence: a potential cause of chronic pelvic pain in women
Tropeano, G., Stasi, C. D., Amoroso, S., Cina, A., & Scambia, G. (2008) · European Journal of Obstetrics & Gynecology and Reproductive Biology · doi:10.1016/j.ejogrb.2007.11.006 · Cited by 39
“Chronic pelvic pain (CPP), defined as lower abdominalpelvic pain of at least 6 months’ duration, is estimated to affect up to 15% of women, and is one the most common reasons for which gynaecologists are consulted [1].”
Background
The Clinical and Economic Consequences of Screening Young Men for Genital Chlamydial Infection
GINOCCHIO, R. H. S., Veenstra, D. L., Connell, F. A., & Marrazzo, J. M. (2003) · Sexually Transmitted Diseases · doi:10.1097/00007435-200302000-00001 · Cited by 39
The Experience of Chronic Illness in Women: A Comparison Between Women with Endometriosis and Women with Chronic Migraine Headaches
Barnack, J. L., & Chrisler, J. C. (2007) · Women & Health · doi:10.1300/j013v46n01_08 · Cited by 38
“Research (Heinberg, Fisher, Wesselmann, Reed, & Haythornthwaite, 2004; Mathias et al., 1996; Rannestad, Eikeland, Helland, & Qvarnstrom, 2000) suggests that CPP has an even stronger negative effect on quality of life than other types of pain do.”
Background
Effects of yogic intervention on pain scores and quality of life in females with chronic pelvic pain
Saxena, R., Gupta, M., Shankar, N., Jain, S., & Saxena, A. (2016) · International Journal of Yoga · doi:10.4103/0973-6131.186155 · Cited by 38
“[8] Symptoms of depression, anxiety, low QOL, low productivity, decreased energy, sexual dysfunction, and relationship problems are also present in these patients of CPP.[9,10] The treatment of CPP entails two aspects, one is the treatment of chronic pain, and the other is the treatment of the underlying cause.”
BackgroundInfluential
Pelvic vein incompetence: clinical perspectives
Riding, D. M., Hansrani, V., & McCollum, C. N. (2017) · Vascular Health and Risk Management · doi:10.2147/vhrm.s132827 · Cited by 38
The role of non-invasive imaging techniques in detecting intra-abdominal adhesions: a systematic review
Gerner-Rasmussen, J., Donatsky, A. M., & Bjerrum, F. (2018) · Langenbeck s Archives of Surgery · doi:10.1007/s00423-018-1732-8 · Cited by 45
Musculoskeletal Causes of Chronic Pelvic Pain: A Systematic Review of Existing Therapies: Part II*
Tu, F. F., As‐Sanie, S., & Steege, J. F. (2005) · Obstetrical & Gynecological Survey · doi:10.1097/01.ogx.0000162246.06900.9f · Cited by 38
Predictors of outcome in a cohort of women with chronic pelvic pain – A follow‐up study
Weijenborg, P. T. M., Kuile, M. M. L., Gopie, J. P., & Spinhoven, P. (2008) · European Journal of Pain · doi:10.1016/j.ejpain.2008.09.002 · Cited by 38
“Chronic pelvic pain (CPP) is a common condition in women (Mathias et al., 1996; Grace and Zondervan, 2004).”
Background
Encyclopedia of Pain
Gebhart, G. F., & Schmidt, R. F. (2013) · Springer eBooks · doi:10.1007/978-3-642-28753-4 · Cited by 38
Optimal management of chronic cyclical pelvic pain: an evidence-based and pragmatic approach
Abbott, J. (2010) · International Journal of Women s Health · doi:10.2147/ijwh.s7991 · Cited by 38
Should women with chronic pelvic pain have adhesiolysis?
Cheong, Y. C., Reading, I., Bailey, S., Sadek, K., Ledger, W. J., & Li, T. C. (2014) · BMC Women s Health · doi:10.1186/1472-6874-14-36 · Cited by 37
“managing CPP annually, and Maastricht these are likely to be underestimates [5,6].”
Background
A Prospective, Multi‐Center, Clinical Trial of a 10‐kHz Spinal Cord Stimulation System in the Treatment of Chronic Pelvic Pain
Tate, J. L., Stauss, T. G., Li, S., Rotte, A., & Subbaroyan, J. (2020) · Pain Practice · doi:10.1111/papr.12932 · Cited by 37
“Chronic pelvic pain (CPP) is characterized by continuous or intermittent pain in the lower abdomen or pelvis lasting at least 6 months that impairs patient functioning and quality of life and can be cyclical or noncyclical in nature.1 CPP is a relatively common condition caused by a variety of complex disorders such a…”
Background

Authors: Mathias, S.
Affiliations: University of North Carolina at Chapel Hill (US)
Corresponding author: Mathias, S
ORCID: Mathias, S
Venue: Obstetrics & Gynecology
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 1996-03
Volume: 87
Issue: 3
Pages: 321-327
ISSN: 0029-7844 (ISSN-L)
DOI: 10.1016/0029-7844(95)00458-0
OpenAlex: W1985935279
Cited by: 1,074
References: 18
Citations by year: 2026: 16 · 2025: 36 · 2024: 29 · 2023: 49 · 2022: 36 · 2021: 45 · 2020: 37 · 2019: 39 · 2018: 50 · 2017: 53 · 2016: 46 · 2015: 38 · 2014: 55 · 2013: 37 · 2012: 51
FWCI: 11.94
Type: journal article
Language: en
Open access: closed
Locations: Obstetrics and Gynecology (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Menstrual Health and Disorders
Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
Keywords: chronic pelvic pain, prevalence, health-related quality of life, labor productivity, health care utilization, endometriosis, health care costs, women's health, lost workdays
MeSH terms: Adolescent, Adult, Chronic Disease, Endometriosis, Female, Health Services Needs and Demand, Humans, Middle Aged, Quality of Life, Socioeconomic Factors, United States, Prevalence, Cost of Illness, Pelvic Pain

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Chronic Pelvic Pain: Prevalence, Health-Related Quality of Life, and Economic Correlates

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