Laparoscopies and pelvic pain

In an article published in the Journal of Obstetrics and Gynaecology, the authors ask the following question: “How can we reduce negative laparoscopies for pelvic pain?” A retrospective audit of women receiving a laparoscopy (76 charts) was completed to determine how thoroughly the subjective examination was completed for women who complained of pelvic pain. Physical exam, the results of any ultrasound examination, reported usage of hormonal therapy, and the recommendation for multidisciplinary care was also assessed retrospectively. This study also aimed to determine if recommended guidelines for the initial assessment of chronic pelvic pain were followed by the physicians. These guidelines were developed by the Royal College of Obstetrics and Gynaecologists (RCOG) and can be accessed by clicking here.

Outcomes of the chart reviews indicated that history-taking was “deficient” and an integrated approach was not utilized much of the time, leading to a poor initial evaluation of the patient. 13% of the charts had no documentation of duration of symptoms. Only 21% of charts noted if the pain was cyclical or non-cyclical and this lead to failure to recognize the option of a trial of hormone therapy. Complaints of dyspareunia were documented for 31.5% of the women, and this, according to the authors, is less than expected based on general population studies and is likely due to poor history taking.

In this study, laparoscopy contributed to diagnosing and treating disease or other significant findings in 45% of the patients. Endometriosis and adhesions were the main findings reported following the procedure. I found it interesting that 50% of the patients who had negative ultrasound studies were found to have positive laparoscopy results. And despite the fact that the RCOG guidelines suggest psychology and physiotherapy referral for women who complain of dyspareunia, only 1 referral for psychosexual counseling was made.

The authors conclude that in order to reduce the number of negative laparoscopies for pelvic pain, a “…structured initial assessment and targeted selection of patients for laparoscopies…” is needed. It also appears that pelvic rehabilitation specialists must continue to address the lack of awareness of potential referral for chronic pelvic pain. Most medical providers and patients are unaware of the scope of the pelvic rehab therapist, and this study certainly highlights the need for more interdisciplinary communication and care provided to the patient who suffers from pelvic pain.