Relationship of pelvic infection and chronic pelvic pain

The approach to the patient with CPP with a history of PID remains a diagnostic challenge even for the experienced clinician. From the initial diagnosis of presumed PID to managing the pain that may result, using an approach that looks at all factors, not just antecedent PID, allows the practicing physician to avoid becoming too narrowly focused in his or her approach. A clinical starting point would assume all possibilities for pelvic pain and evaluate for each. Given the history of one or more episodes of PID, especially if documented with a prior laparoscopy, earlier investigation for adhesions could be justified in selected patients. If the pelvic examination further suggests a pelvic source, a laparoscopy performed early rather than late in the work-up would seem appropriate. The key to management of the patients who have CPP following PID is to use any and all available diagnostic and therapeutic modalities to identify the source(s) before assuming that the patient suffers only from the known sequelae of PID.