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Preface
It is coming up to 7 years since I published my book about Chronic Pelvic Pain and Abnormal Uterine Bleeding, and almost 10 years since I started researching the two subjects, to prepare that book. Despite the great efforts made by the International Pelvic Pain Society and similar organisations to educate medical practitioners and the public, the same grim picture which prevailed more than 10 years ago, is sill prevalent. Millions of women over the world still suffer silently from chronic pelvic pain, without having a clue whom to see, and how they can go about their problem. There is more about this issue in the Epidemiology section, to what is prevalent in the Western Countries.
Since publishing the book alluded to above, I had the pleasure of visiting few non-European countries, and spoke to many doctors working in other similar countries during conferences. There is a lull about this problem, and a general believe that chronic pelvic pain does not exist, or women may be immune against such western diseases. I felt very awkward when senior doctors from those countries made categorical statements that they do not see endometriosis cases, and tried to put forward some explanations. These were based on climate, type of food, environmental factors, and racial differences. I could not accept that argument, since most of the affluent Middle Eastern Countries, for example, are cosmopolitan. This reminded me of the classical teaching, during my medical student years, in the late sixties and early seventies of the last century. Endometriosis was described as a disease of upper class, sexually frustrated white women. That was the official teaching then!
A simple question needs a simple answer. Why should non-European nationals are inflicted, as much with endometriosis as locals in Europe, and allegedly do not get the same condition when they live in the Middle East or Africa, for example? It did not make sense. This is especially so, since I saw the worst cases of advanced endometriosis ever in my experience, when I practiced in these countries, bearing in mind that my career focused on advanced laparoscopic management of this disease, for more than two decades.
In the epidemiology section, there is some statistics from England and the United States about medical staff attitude towards patients with chronic pelvic pain. Unfortunately, there is no such data from third world countries. However, my story with one doctor in an African country may set the tone. He thought I would have had more readers, and made more money, if I had written about the 'gentleman thief' Arsène Lupin, rather than chronic pelvic pain. In his view, one pessary and four tablets were all what was needed to cure pelvic pain; so why was the fuss?
The situation is not helped by the insurance companies, as they do not usually authorise laparoscopic surgery for pelvic pain, unless doctors provided evidence of disease. This is mainly in the form of an ovarian cyst image for endometriosis. This is in spite of the fact that only 15 -20% of women with endometriosis show ovarian chocolate cyst, on ultrasound scanning. So almost 80- 85% of the patients, retrospectively shown to have endometriosis, would be denied prior authorisation to have surgery, on a false assumption. May be, the situation would have been different if endometriosis, dysmenorrhoea and dyspareunia were not exclusively female problems!
I hope you find this book helpful, well illustrated and informative. Let us all push in one direction, to help young women to have a pleasant life, not marred by pain during their natural physiological acts of menstruation, defaecation, urination and having sexual intimacy. The public will need to be educated, and local lay associations for chronic pelvic pain should be established and supported, in all countries. Let affected women have a voice of their own.
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