Intended for healthcare professionals


Factors predisposing women to chronic pelvic pain: systematic review

BMJ 2006; 332 doi: (Published 30 March 2006) Cite this as: BMJ 2006;332:749
  1. Pallavi Latthe, subspecialty trainee in urogynaecology (pallavi{at},
  2. Luciano Mignini, WHO research fellow1,
  3. Richard Gray, professor of medical statistics2,
  4. Robert Hills, principal statistician2,
  5. Khalid Khan, professor1
  1. 1 Academic Department of Obstetrics and Gynaecology, University of Birmingham, Birmingham B15 2TG
  2. 2 Clinical Trials Unit, University of Birmingham, Edgbaston, Birmingham
  1. Correspondence to: P Latthe
  • Accepted 18 November 2005


Objective To evaluate factors predisposing women to chronic and recurrent pelvic pain.

Design, data sources, and methods Systematic review of relevant studies without language restrictions identified through Medline, Embase, PsycINFO, Cochrane Library. SCISEARCH, conference papers, and bibliographies of retrieved primary and review articles. Two reviewers independently extracted data on study characteristics, quality, and results. Exposure to risk factors was compared between women with and without pelvic pain. Results were pooled within subgroups defined by type of pain and risk factors.

Results There were 122 studies (in 111 articles) of which 63 (in 64 286 women) evaluated 54 risk factors for dysmenorrhoea, 19 (in 18 601 women) evaluated 14 risk factors for dyspareunia, and 40 (in 12 040 women) evaluated 48 factors for non-cyclical pelvic pain. Age < 30 years, low body mass index, smoking, earlier menarche (< 12 years), longer cycles, heavy menstrual flow, nulliparity, premenstrual syndrome, sterilisation, clinically suspected pelvic inflammatory disease, sexual abuse, and psychological symptoms were associated with dysmenorrhoea. Younger age at first childbirth, exercise, and oral contraceptives were negatively associated with dysmenorrhoea. Menopause, pelvic inflammatory disease, sexual abuse, anxiety, and depression were associated with dyspareunia. Drug or alcohol abuse, miscarriage, heavy menstrual flow, pelvic inflammatory disease, previous caesarean section, pelvic pathology, abuse, and psychological comorbidity were associated with an increased risk of non-cyclical pelvic pain.

Conclusion Several gynaecological and psychosocial factors are strongly associated with chronic pelvic pain. Randomised controlled trials of interventions targeting these potentially modifiable factors are needed to assess their clinical relevance in chronic pelvic pain.


  • Contributors PL was responsible for conception, design, search, study selection, data extraction and synthesis, and writing the manuscript. LM extracted data and created tables. RH was responsible for statistical analysis and figures. RG was responsible for statistical analysis, interpretation, and revision of manuscript. KK was responsible for conception, design, data synthesis, and writing and revising the manuscript. PL and KK are guarantors.

  • Funding PL was a research fellow coordinating the laparoscopic uterine nerve ablation trial for chronic pelvic pain and was funded by WellBeing of Women grant CF/371 while performing this systematic review.

  • Competing interests None declared.

  • Ethical approval Not required.

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