Adverse Childhood Experiences Among Gynecology Patients With Chronic Pelvic Pain

To compare adverse childhood experiences (ACEs) in women with chronic pelvic pain with a control group, and describe occurrence of specific ACEs in women with chronic pelvic pain.

This case-control study examined the relationship between history of ACEs, traumatic events occurring during childhood as defined by the Centers for Disease Control and Prevention (CDC), and chronic pelvic pain. Patients diagnosed with chronic pelvic pain (n=60) were age-matched to a control group of women without chronic pelvic pain (n=60). All participants completed validated measures to detect for presence of any of the 11 ACEs as identified by the CDC's Behavioral Risk Factor Surveillance System ACE Module.

Mean participant age was 40 (±11 years). Total numbers of ACEs were elevated in chronic pelvic pain participants compared with a control group (median 4 [interquartile range 2-6] vs median 1 [interquartile range 0-4], P<.001) and 53% of chronic pelvic pain participants had four or more ACEs, compared with 27% of the control group (odds ratio [OR] 3.14; 95% CI 1.46-6.75). All categories of abuse were more prevalent in chronic pelvic pain compared with the control group: physical (43% vs 15%, OR 4.3; 95% CI 1.8-10.4; P=.001), sexual (55% vs 23%, OR 4.0; 95% CI 1.8-8.8; P<.001) and verbal or emotional (62% vs 33%, OR 3.2; 95% CI 1.5-6.8; P=.003). Regarding household challenges, the subcategory most prevalent in chronic pelvic pain participants compared with the control group was that of witnessed domestic violence (35% vs 8%, OR 5.9; 95% CI 2.1-17.1, P<.001).

Chronic pelvic pain participants had a greater than threefold odds of having a history of childhood abuse and having witnessed domestic violence during childhood compared with the control group. Women with chronic pelvic pain had increased numbers of ACEs and 53% had four or more ACEs, crossing a threshold that others have found to predict poor overall health outcomes.