Rapid responses are electronic letters to the editor. They enable our users to debate issues raised in articles published on thebmj.com. Although a selection of rapid responses will be included online and in print as readers' letters, their first appearance online means that they are published articles. If you need the url (web address) of an individual response, perhaps for citation purposes, simply click on the response headline and copy the url from the browser window. Letters are indexed in PubMed.
Pelvic pain is a well-recognised, if overlooked, consequence of Ehlers Danlos Syndrome (EDS) ¹ . When seeing women with pelvic pain who have no obvious pathology to explain it, we routinely look for signs of EDS. If signs are present it offers a clear explanation for the pain, as well as other associated symptoms. Whilst there is no cure for EDS, patients frequently value getting the diagnosis and explanation as it validates their symptoms.
We would suggest in cases of unexplained pelvic pain in women, investigating for EDS is very useful. Getting an explanation validates the patient’s pain, and their pain is no longer unexplained. Which is far better than being prescribed Gabapentin.
Whilst we tend to consider endometriosis, ovarian cysts and pelvic inflammatory disease as the common causes of pelvic pain, we overlook EDS. But to paraphrase Sherlock Holmes in The Sign of Four, it is only when you have eliminated the impossible, whatever remains, however improbable, must be the truth.
Marco Castori (2016) Pain in Ehlers-Danlos syndromes: manifestations, therapeutic strategies and future perspectives, Expert Opinion on Orphan Drugs, 4:11,1145-1158, DOI: 10.1080/21678707.2016.1238302