It is a known fact that chronic pelvic pain has more than one single cause. Dealing with the more obvious cause may only help temporarily in easing the symptoms. With the current knowledge regarding pain conversion, allodynia, hyperalgesia and somatisation, we need a multidisciplinary approach to consider all these aspects. This will also help in dealing with the entanglement between gynaecological and nongynaecological causes. Such a team should be broad based, including interested and experienced Gynaecologists, Urologists, Colorectal Surgeons, Pain Management Specialists, Gastroenterologists, Psychologists / Psychiatrists, Counsellors, Physiotherapists and Nutritionists. The ideal lead person should be an experienced Nurse Coordinator, to arrange smooth running of the unit, and to guard against any patient falling through the net. The need for special protocols, patients questionnaires, facilities for 3D ultrasound and other types of imaging, as well as using minimally invasive surgical techniques have improved the outcome for these patients in many dedicated units.
I am presenting this book as a new and upgraded version of the first book published in 2009, without any major consideration for abnormal uterine bleeding. I learnt a lot over the last few years, bearing in mind that I started researching and writing the first book in 2007. I have since worked in different areas, and came to know how culture, local habits and resources affect women chances of having the proper care they deserve.
The primary objective is to raise the awareness of young gynaecologists and primary care providers to such an important issue, which has negative impact on the lives of many young women. Primary care providers have the main responsibility with parents to make sure that young adolescents with chronic pelvic pelvic pain should see a specialist. On the other hand, senior doctors with no special expertise in this field should pass over patients with such a problem to other colleagues who are involved day in and day out in the management of this problem. This is specially important when surgery is required, since the first surgical procedure usually is the most important to deal with the patients' problems. Furthermore, regular follow up of these patients in such dedicated clinics, under the supervision of experienced practitioners usually gives better final clinical outcome.