Psychological and endocrine correlates of chronic pelvic pain associated with adhesions

Chronic pelvic pain (CPP) is a frequent and often unexplained gynecological complaint. We attempted to evaluate stress history, psychological features and hypothalamic-pituitary-adrenal (HPA) axis function in a group of patients suffering from CPP associated with pelvic adhesions. We recruited 10 patients with CPP and adhesions and 14 painfree, infertile control patients who underwent gynecological examination and diagnostic laparoscopy in a general hospital. Psychological assessment included structured interviews on sexual and physical abuse experiences and major life events as well as questionnaires on pain characteristics and depression. To evaluate HPA axis function, we measured plasma adrenocorticotropin (ACTH) and salivary cortisol responses to the administration of 100 micrograms human corticotropin-releasing factor (CRF). Results revealed high, but not statistically increased, prevalence rates of sexual and physical abuse for patients with CPP and adhesions as compared to controls. Patients with CPP and adhesions reported a significantly higher total number of major life events. Mean depression scores were normal in both groups. Patients with CPP and adhesions demonstrated normal plasma ACTH, but decreased salivary cortisol levels in the CRF stimulation test. These preliminary findings suggest that stress and neuroendocrine changes may also contribute to the pathophysiology of CPP with an identified organic correlate.