Informed, engaged communities for health

Filter by Categories
#PHAAThinkTank2023
Aged care
Budgets
Federal Budget 2023-2024
Federal Budget October 2022
Federal Budget 2022-23
Federal Budget 2021-22
Budget2020Health
Federal Budget 2020-21
Federal Budget 2019-20
Climate and health
National Health and Climate Strategy
#HealthyCOP28
Climate emergency
Heatwaves
Healthcare sustainability
#CoveringClimateNow
#HealthyCOP27
#HealthyCOP26
COVID collection
Long COVID
COVID-19
COVIDwrap
COVID SNAPS
#JusticeCOVID
Caring for the Frontline
COVIDglobalMHseries
Croakey Conference News Service
#GreenHealthForum23
#hpsymposium2023
#NMS23
#HEAL2023
#ASMIRT2023
#NSPC23
Our Democracy Forum
#AskMSF
#Lowitja2023
#16nrhc
#GreenHealthForum22
#Heal2022
#ICEM22
#NAISA22
#NNF2022
#RANZCP2022
#RethinkAddiction
#RTP22
Choosing Wisely National Meeting 2022
Equally Well 2022 Symposium
GiantSteps22
Croakey Professional Services
NHLF series
#KidneyCareTogether
ACSQHC series
ACSQHC series 2022
ACSQHC series 2021
ACSQHC series 2020
ACSQHC series 2019
CATSINaM 25 Years
Croakey projects
#CroakeyLIVE #DigitalNationBuilding
#CroakeyLIVE #VoiceForHealth
The Health Wrap
ICYMI
@WePublicHealth
@WePublicHealth2023
#CroakeyVOICES
#SpeakingOurMinds
Croakey longreads
#CroakeyREAD
CroakeyEXPLORE
#PHAAThinkTank 2022
Summer reading 2022-2023
CroakeyGO
#CroakeyGO #NavigatingHealth
#GamblingHarms
#HeatwaveHealth
Mapping CroakeyGo
Determinants of health
Environmental determinants of health
Social determinants of health
Discrimination
Racism
Justice and policing
Poverty
Newstart/JobSeeker
Education
Housing
Internet access
Justice Reinvestment
Social policy
Commercial determinants of health
fossil fuels
Alcohol
Digital platforms
Food and beverages
Sugar tax
Tobacco
Vaping
Plain packaging
Gambling
Pharmaceutical industry
Arms industry
Disasters and extreme weather events
Disasters
Extreme weather events
Bushfires
Bushfire-emergency 2019-2020
Floods 2023
Floods 2022
Floods 2021
Floods 2011
Donor-funded journalism
Donor-funded journalism – 2023
Donor-funded journalism – 2022
Donor-funded journalism – 2021
Donor-funded journalism – 2020
Elections
#NSWvotesHealth2023
Victorian election 2022
Federal Election 2022
The Election Wrap 2022
#QldVotesHealth
SA election 2022
WA election 2021
Tasmanian election 2021
First Nations
Indigenous health
Uluru Statement
The Voice
Community controlled sector
Cultural determinants of health
Cultural safety
Social and emotional wellbeing
Indigenous education
Lowitja Institute
NT Intervention
WA community closures
Acknowledgement
#CTG10
#NTRC
#RCIADIC30Years
General health matters
Consumer health matters
Cancer
Cardiovascular disease
Chronic conditions
Non communicable diseases
Diabetes
Oral health
Disabilities
Fetal Alcohol Spectrum Disorders (FASD)
Genetics
Medical marijuana
Mental health
Suicide
Trauma
LGBTQIA+
HIV/AIDS
Women's health
HRT
Abortion
Men's health
Youth health
Child health
Pregnancy and childbirth
Organ transplants
Pain
Sexual health
Infectious diseases
Influenza
Mpox
Swine flu
Death and dying
Euthanasia
Global health matters
Global health
WHO
Conflict and war
Asylum seeker and refugee health
#WorldInTurmoil
Ebola
NHS
Health policy and systems
MyMedicare
Health reform
Workforce matters
Health financing and costs
Health regulation
Strengthening Medicare Taskforce 2022
Co-design
TGA
Royal Commissions
National Commission of Audit 2014
National Health Performance Authority
Pharmaceutical Benefits Scheme
Private health insurance
Healthcare
Primary healthcare
cohealth
Social prescribing
Rural and remote health
General practice
International medical graduates
Primary Health Networks
NDIS
Nursing and midwifery
Australian Medical Association
Allied healthcare
Pharmacy
Paramedics
Pathology
Naturopathy
Hospitals
Emergency departments and care
Palliative care
Safety and quality of healthcare
Adverse events
Choosing Wisely
Co-payments
Out of pocket costs
Complementary medicines
Conflicts of interest
Health ethics
Digital technology
Telehealth
E-health
Equally Well
Health Care Homes
Medicare Locals
MyHospitals website
Screening
Surgery
Tests
Media and health
Media-related issues
Public interest journalism
Misinformation and disinformation
Social media and healthcare
Health & medical marketing
The Conversation
Media Doctor Australia
News about Croakey
Public health and population health
Artificial intelligence
Public health
Prevention
Health inequalities
Human rights
Health in All Policies
Health impact assessment
Legal issues
Australian Centre for Disease Control
VicHealth
Health literacy
Health communications
Vaccination
Air pollution
Physical activity
Sport
Obesity
Road safety
Transport
Gun control
Illicit drugs
Injuries
Marriage equality
Occupational health
Violence
Weight loss products
#PreventiveHealthStrategy
#UnmetNeedsinPublicHealth
Government 2.0
Web 2.0
Nanny state
National Preventive Health Agency
Research matters
Health and medical research
#MRFFtransparency
Evidence-based issues
Cochrane Collaboration
Health and medical education
NHMRC
The Croakey Archives
#cripcroakey
#HealthEquity16
#HealthMatters
#IHMayDay (all years)
#IHMayDay 2014
#IHMayDay15
#IHMayday16
#IHMayDay17
#IHMayDay18
#LoveRural 2014
Croakey Conference News Service 2013 – 2021
2021 conferences
#21OPCC
#BackToTheFire
#FoodGovernance2021
#GiantSteps21
#GreenHealthForum21
#HealthClimateSolutions21
#HearMe21
#IndigenousClimateJustice21
#NNF2021
#RANZCP2021
#ShiftingGearsSummit
#ValueBasedCare
#WCepi2021
#YHFSummit
2020 conferences
#2020ResearchExcellence
#Govern4Health
#HealthReImagined
#SAHeapsUnfair
2019 Conferences
#ACEM19
#CPHCE19
#EquallyWellAust
#GiantSteps19
#HealthAdvocacyWIM
#KTthatWorks
#LowitjaConf2019
#MHAgeing
#NNF2019
#OKtoAsk2019
#RANZCOG19
#RANZCP2019
#ruralhealthconf
#VMIAC2019
#WHOcollabAHPRA
2018 conferences
#6rrhss
#ACEM18
#AHPA2018
#ATSISPC18
#CPHCE
#MHED18
#NDISMentalHealth
#Nurseforce
#OKToAsk2018
#RANZCOG18
#ResearchIntoPolicy
#VHAawards
#VMIACAwards18
#WISPC18
2017 conferences
#17APCC
#ACEM17
#AIDAconf2017
#BTH20
#CATSINaM17
#ClimateHealthStrategy
#IAHAConf17
#IDS17
#LBQWHC17
#LivingOurWay
#OKtoAskAu
#OTCC2017
#ResearchTranslation17
#TheMHS2017
#VMIACConf17
#WCPH2017
Australian Palliative Care Conference
2016 conferences
#AHHAsim16
#AHMRC16
#ANROWS2016
#ATSISPEP
#AusCanIndigenousWellness
#cphce2016
#CPHCEforum16
#CRANAplus2016
#IAMRA2016
#LowitjaConf2016
#PreventObesity16
#TowardsRecovery
#VMIAC16
#WearablesCEH
#WICC2016
2015 conferences
#CPHCEforum
#CRANAplus15
#HSR15
#NRHC15
#OTCC15
Population Health Congress 2015
2014 conferences
#IPCHIV14
AIDA Conference 2014
Congress Lowitja 2014
CRANAplus conference 2014
Cultural Solutions - Healing Foundation forum 2014
Lowitja Institute Continuous Quality Improvement conference 2014
National Suicide Prevention Conference 2014
Racism and children/youth health symposium 2014
Rural & Remote Health Scientific Symposium 2014
2013 conferences
Australian Centre for Health Services Innovation Forum 2013
Australian Health Promotion Association Conference 2013
Closing the Credibility Gap 2013
CRANAplus Conference 2013
FASD Conference 2013
Health Workforce Australia 2013
International Health Literacy Network Conference 2013
NACCHO Summit 2013
National Rural Health Conference 2013
Oceania EcoHealth Symposium 2013
PHAA conference 2013
Croakey Professional Services archive
#CommunityControl
#CommunityControl Twitter Festival
#COVIDthinktank21
Lowitja Indigenous knowledge translation series
Croakey projects archive
#CommunityMatters
#CroakeyFundingDrive 2022
#CroakeyLIVE #Budget2021Health
#CroakeyLIVE #USvotesHealth
#CroakeyLIVE Federal election 2022
#CroakeyYOUTH
#HousingJusticeAus
#IndigenousHealthSummit
#IndigenousNCDs
#JustClimate
#JustJustice
#LookingLocal
#OutOfPocket
#OutOfTheBox
#RuralHealthJustice
#TalkingTeeth
@WePublicHealth2022
@WePublicHealth2021
@WePublicHealth2020
AroundTheTraps
Croakey register of influence
Croakey Register of Influencers in Public Health
Croakey Register of Unreleased Documents
Gavin Mooney
Inside Story
Journal Watch
Naked Doctor
Poems of Public Health
Summer reading 2021-2022
Summer reading 2020-2021
Summer Reading 2019-2020
Summer Reading 2017-2018
Summer Reading 2016-2017
The Koori Woman
TOO MUCH of a Good Thing
Wonky Health
CroakeyGO archive 2017 – 2018
CroakeyGo 2018
#CroakeyGO #QuantumWords 2018
#CroakeyGO #VicVotes 2018
#CroakeyGO Albury 2018
#CroakeyGO Callan Park 2018
#CroakeyGO Carnarvon 2018
#CroakeyGO Marrickville 2018
#CroakeyGO Palm Island 2018
CroakeyGo 2017
#CroakeyGO Adelaide 2017
#CroakeyGO Melbourne 2017
#CroakeyGO Newcastle 2017
#CroakeyGO Sydney 2017
Elections and Budgets 2013 – 2019
#AusVotesHealth Twitter Festival 2019
#Health4NSW
Federal Election 2019
NSW Election 2019
Federal Budget 2018-19
Federal Budget 2017/18
NZ Election 2017
Federal Budget 2016-17
Federal Election 2016
#HealthElection16
NT Election 2016
Federal Budget 2015-16
Qld Election 2015
NSW Election 2015
Federal Budget 2014-15
Victorian Election 2014
Federal Budget 2013-14
Federal Election 2013
Federal Budget 2012-2013
Federal Budget 2011
Federal Budget 2010
Federal Election 2010
Federal Budget 2009-2010
Support non-profit public interest journalism
Filter by Categories
#PHAAThinkTank2023
Aged care
Budgets
Federal Budget 2023-2024
Federal Budget October 2022
Federal Budget 2022-23
Federal Budget 2021-22
Budget2020Health
Federal Budget 2020-21
Federal Budget 2019-20
Climate and health
National Health and Climate Strategy
#HealthyCOP28
Climate emergency
Heatwaves
Healthcare sustainability
#CoveringClimateNow
#HealthyCOP27
#HealthyCOP26
COVID collection
Long COVID
COVID-19
COVIDwrap
COVID SNAPS
#JusticeCOVID
Caring for the Frontline
COVIDglobalMHseries
Croakey Conference News Service
#GreenHealthForum23
#hpsymposium2023
#NMS23
#HEAL2023
#ASMIRT2023
#NSPC23
Our Democracy Forum
#AskMSF
#Lowitja2023
#16nrhc
#GreenHealthForum22
#Heal2022
#ICEM22
#NAISA22
#NNF2022
#RANZCP2022
#RethinkAddiction
#RTP22
Choosing Wisely National Meeting 2022
Equally Well 2022 Symposium
GiantSteps22
Croakey Professional Services
NHLF series
#KidneyCareTogether
ACSQHC series
ACSQHC series 2022
ACSQHC series 2021
ACSQHC series 2020
ACSQHC series 2019
CATSINaM 25 Years
Croakey projects
#CroakeyLIVE #DigitalNationBuilding
#CroakeyLIVE #VoiceForHealth
The Health Wrap
ICYMI
@WePublicHealth
@WePublicHealth2023
#CroakeyVOICES
#SpeakingOurMinds
Croakey longreads
#CroakeyREAD
CroakeyEXPLORE
#PHAAThinkTank 2022
Summer reading 2022-2023
CroakeyGO
#CroakeyGO #NavigatingHealth
#GamblingHarms
#HeatwaveHealth
Mapping CroakeyGo
Determinants of health
Environmental determinants of health
Social determinants of health
Discrimination
Racism
Justice and policing
Poverty
Newstart/JobSeeker
Education
Housing
Internet access
Justice Reinvestment
Social policy
Commercial determinants of health
fossil fuels
Alcohol
Digital platforms
Food and beverages
Sugar tax
Tobacco
Vaping
Plain packaging
Gambling
Pharmaceutical industry
Arms industry
Disasters and extreme weather events
Disasters
Extreme weather events
Bushfires
Bushfire-emergency 2019-2020
Floods 2023
Floods 2022
Floods 2021
Floods 2011
Donor-funded journalism
Donor-funded journalism – 2023
Donor-funded journalism – 2022
Donor-funded journalism – 2021
Donor-funded journalism – 2020
Elections
#NSWvotesHealth2023
Victorian election 2022
Federal Election 2022
The Election Wrap 2022
#QldVotesHealth
SA election 2022
WA election 2021
Tasmanian election 2021
First Nations
Indigenous health
Uluru Statement
The Voice
Community controlled sector
Cultural determinants of health
Cultural safety
Social and emotional wellbeing
Indigenous education
Lowitja Institute
NT Intervention
WA community closures
Acknowledgement
#CTG10
#NTRC
#RCIADIC30Years
General health matters
Consumer health matters
Cancer
Cardiovascular disease
Chronic conditions
Non communicable diseases
Diabetes
Oral health
Disabilities
Fetal Alcohol Spectrum Disorders (FASD)
Genetics
Medical marijuana
Mental health
Suicide
Trauma
LGBTQIA+
HIV/AIDS
Women's health
HRT
Abortion
Men's health
Youth health
Child health
Pregnancy and childbirth
Organ transplants
Pain
Sexual health
Infectious diseases
Influenza
Mpox
Swine flu
Death and dying
Euthanasia
Global health matters
Global health
WHO
Conflict and war
Asylum seeker and refugee health
#WorldInTurmoil
Ebola
NHS
Health policy and systems
MyMedicare
Health reform
Workforce matters
Health financing and costs
Health regulation
Strengthening Medicare Taskforce 2022
Co-design
TGA
Royal Commissions
National Commission of Audit 2014
National Health Performance Authority
Pharmaceutical Benefits Scheme
Private health insurance
Healthcare
Primary healthcare
cohealth
Social prescribing
Rural and remote health
General practice
International medical graduates
Primary Health Networks
NDIS
Nursing and midwifery
Australian Medical Association
Allied healthcare
Pharmacy
Paramedics
Pathology
Naturopathy
Hospitals
Emergency departments and care
Palliative care
Safety and quality of healthcare
Adverse events
Choosing Wisely
Co-payments
Out of pocket costs
Complementary medicines
Conflicts of interest
Health ethics
Digital technology
Telehealth
E-health
Equally Well
Health Care Homes
Medicare Locals
MyHospitals website
Screening
Surgery
Tests
Media and health
Media-related issues
Public interest journalism
Misinformation and disinformation
Social media and healthcare
Health & medical marketing
The Conversation
Media Doctor Australia
News about Croakey
Public health and population health
Artificial intelligence
Public health
Prevention
Health inequalities
Human rights
Health in All Policies
Health impact assessment
Legal issues
Australian Centre for Disease Control
VicHealth
Health literacy
Health communications
Vaccination
Air pollution
Physical activity
Sport
Obesity
Road safety
Transport
Gun control
Illicit drugs
Injuries
Marriage equality
Occupational health
Violence
Weight loss products
#PreventiveHealthStrategy
#UnmetNeedsinPublicHealth
Government 2.0
Web 2.0
Nanny state
National Preventive Health Agency
Research matters
Health and medical research
#MRFFtransparency
Evidence-based issues
Cochrane Collaboration
Health and medical education
NHMRC
The Croakey Archives
#cripcroakey
#HealthEquity16
#HealthMatters
#IHMayDay (all years)
#IHMayDay 2014
#IHMayDay15
#IHMayday16
#IHMayDay17
#IHMayDay18
#LoveRural 2014
Croakey Conference News Service 2013 – 2021
2021 conferences
#21OPCC
#BackToTheFire
#FoodGovernance2021
#GiantSteps21
#GreenHealthForum21
#HealthClimateSolutions21
#HearMe21
#IndigenousClimateJustice21
#NNF2021
#RANZCP2021
#ShiftingGearsSummit
#ValueBasedCare
#WCepi2021
#YHFSummit
2020 conferences
#2020ResearchExcellence
#Govern4Health
#HealthReImagined
#SAHeapsUnfair
2019 Conferences
#ACEM19
#CPHCE19
#EquallyWellAust
#GiantSteps19
#HealthAdvocacyWIM
#KTthatWorks
#LowitjaConf2019
#MHAgeing
#NNF2019
#OKtoAsk2019
#RANZCOG19
#RANZCP2019
#ruralhealthconf
#VMIAC2019
#WHOcollabAHPRA
2018 conferences
#6rrhss
#ACEM18
#AHPA2018
#ATSISPC18
#CPHCE
#MHED18
#NDISMentalHealth
#Nurseforce
#OKToAsk2018
#RANZCOG18
#ResearchIntoPolicy
#VHAawards
#VMIACAwards18
#WISPC18
2017 conferences
#17APCC
#ACEM17
#AIDAconf2017
#BTH20
#CATSINaM17
#ClimateHealthStrategy
#IAHAConf17
#IDS17
#LBQWHC17
#LivingOurWay
#OKtoAskAu
#OTCC2017
#ResearchTranslation17
#TheMHS2017
#VMIACConf17
#WCPH2017
Australian Palliative Care Conference
2016 conferences
#AHHAsim16
#AHMRC16
#ANROWS2016
#ATSISPEP
#AusCanIndigenousWellness
#cphce2016
#CPHCEforum16
#CRANAplus2016
#IAMRA2016
#LowitjaConf2016
#PreventObesity16
#TowardsRecovery
#VMIAC16
#WearablesCEH
#WICC2016
2015 conferences
#CPHCEforum
#CRANAplus15
#HSR15
#NRHC15
#OTCC15
Population Health Congress 2015
2014 conferences
#IPCHIV14
AIDA Conference 2014
Congress Lowitja 2014
CRANAplus conference 2014
Cultural Solutions - Healing Foundation forum 2014
Lowitja Institute Continuous Quality Improvement conference 2014
National Suicide Prevention Conference 2014
Racism and children/youth health symposium 2014
Rural & Remote Health Scientific Symposium 2014
2013 conferences
Australian Centre for Health Services Innovation Forum 2013
Australian Health Promotion Association Conference 2013
Closing the Credibility Gap 2013
CRANAplus Conference 2013
FASD Conference 2013
Health Workforce Australia 2013
International Health Literacy Network Conference 2013
NACCHO Summit 2013
National Rural Health Conference 2013
Oceania EcoHealth Symposium 2013
PHAA conference 2013
Croakey Professional Services archive
#CommunityControl
#CommunityControl Twitter Festival
#COVIDthinktank21
Lowitja Indigenous knowledge translation series
Croakey projects archive
#CommunityMatters
#CroakeyFundingDrive 2022
#CroakeyLIVE #Budget2021Health
#CroakeyLIVE #USvotesHealth
#CroakeyLIVE Federal election 2022
#CroakeyYOUTH
#HousingJusticeAus
#IndigenousHealthSummit
#IndigenousNCDs
#JustClimate
#JustJustice
#LookingLocal
#OutOfPocket
#OutOfTheBox
#RuralHealthJustice
#TalkingTeeth
@WePublicHealth2022
@WePublicHealth2021
@WePublicHealth2020
AroundTheTraps
Croakey register of influence
Croakey Register of Influencers in Public Health
Croakey Register of Unreleased Documents
Gavin Mooney
Inside Story
Journal Watch
Naked Doctor
Poems of Public Health
Summer reading 2021-2022
Summer reading 2020-2021
Summer Reading 2019-2020
Summer Reading 2017-2018
Summer Reading 2016-2017
The Koori Woman
TOO MUCH of a Good Thing
Wonky Health
CroakeyGO archive 2017 – 2018
CroakeyGo 2018
#CroakeyGO #QuantumWords 2018
#CroakeyGO #VicVotes 2018
#CroakeyGO Albury 2018
#CroakeyGO Callan Park 2018
#CroakeyGO Carnarvon 2018
#CroakeyGO Marrickville 2018
#CroakeyGO Palm Island 2018
CroakeyGo 2017
#CroakeyGO Adelaide 2017
#CroakeyGO Melbourne 2017
#CroakeyGO Newcastle 2017
#CroakeyGO Sydney 2017
Elections and Budgets 2013 – 2019
#AusVotesHealth Twitter Festival 2019
#Health4NSW
Federal Election 2019
NSW Election 2019
Federal Budget 2018-19
Federal Budget 2017/18
NZ Election 2017
Federal Budget 2016-17
Federal Election 2016
#HealthElection16
NT Election 2016
Federal Budget 2015-16
Qld Election 2015
NSW Election 2015
Federal Budget 2014-15
Victorian Election 2014
Federal Budget 2013-14
Federal Election 2013
Federal Budget 2012-2013
Federal Budget 2011
Federal Budget 2010
Federal Election 2010
Federal Budget 2009-2010

Chronic pelvic pain: a complex condition requiring informed care

The complexities of chronic pelvic pain were discussed in-depth at the recent Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) annual scientific meeting in Melbourne.

Amy Coopes reports for the Croakey Conference News Service.


Amy Coopes writes:

Chronic pelvic pain, described as “one of the most enigmatic conditions in gynaecology”, encompasses so much than endometriosis and is a multifactorial, complex condition, according to speakers at a recent medical conference.

Affecting one in nine Australian women aged 40-44 according to a recent report by the Australian Institute for Health and Welfare, chronic pelvic pain involves links to other pain syndromes, neurological changes, and has a strong psychological dimension requiring multidisciplinary treatment.

Chronic pelvic pain was front and centre at the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) annual scientific meeting in Melbourne this month, with a plenary session featuring speakers from a host of disciplines, including physiotherapy and psychology, as well as a focus on priorities in endometriosis.

The Federal Government nominated the condition as a research priority last year, unveiling the first-ever National Action Plan for Endometriosis and pledging $15 million to advance this agenda.

Dr Sawsan As-Sanie, past president of the International Pelvic Pain Society, was keynote speaker for the plenary session. She delivered a masterclass in the drivers, diagnosis and management of chronic pelvic pain, which she described as “one of the most enigmatic conditions in gynaecology”.

She said the condition was rarely commensurate with what lesions (if any) could be seen.

A vicious cycle

Instead, As-Sanie said the evidence pointed to chronic pelvic pain being all about the brain, with changes seen in structure, volume and function, and the condition often featuring a constellation of other symptoms, including poor non-restorative sleep, memory problems, mood disorders and an exaggerated response to both internal (bodily functions) and external (sound, light) stimuli.

Characterising it as a “widespread disorder of sensory dysregulation” at the level of the central nervous system, As-Sanie said chronic pelvic pain was just one of a number of chronic pain syndromes that, along with chronic fatigue syndrome and fibromyalgia, also affected the bowel, bladder and vulva, and shared features such as multifocal widespread pain, exacerbation during times of stress and a poor response to opioids.

Chronic pain syndromes are up to two times more common in women and had strong genetic and familial underpinnings, she said.

Patients with chronic pelvic pain often reported a higher lifetime history of pain (for example, headaches and period pain), and As-Sanie said gender bias and a tendency to dismiss or downplay pain reports – particularly from adolescents and young girls – was very much still an issue in the health system.

Given this, As-Sanie said it was so important to take a thorough history before resorting to surgical interventions that would ultimately be futile.

Instead, she urged colleagues to understand chronic pain as a vicious cycle in which fatigue and the functional consequences must be addressed.

She presented evidence showing that, for these patients, non-pharmaceutical therapies including education, aerobic exercise and cognitive behaviour therapy (CBT) were superior to drugs, and shared some comprehensive resources for doctors and patients.

Key points

As-Sanie had seven key messages for her colleagues:

  1. Chronic pelvic pain is a symptom, and there are many overlapping pathways that lead to it
  2. Each woman will have a unique combination of peripheral and central mechanisms at play
  3. Women with endometriosis and/or chronic pelvic pain are at increased risk of developing other chronic pain conditions
  4. Patients with central sensitisation, the key driver of such conditions, have more acute pain postoperatively and are slower to recover
  5. They respond differently to therapy, and surgery is less likely to help with their symptoms
  6. Early treatment of the initial insult can help prevent transition from acute to chronic pain; treatment delay associated with increased connectivity between pain regulatory regions in the brain
  7. Hysterectomy is not always a cure for all women with endometriosis or chronic pelvic pain.

Watch our interview with As-Sanie

An ethical imperative

Physiotherapist Jen Langford stressed the importance of a biopsychosocial approach, talking through the physical and psychological domains. ‘Quiet the pelvis and calm the nervous system’ was her mantra, she said.

The single most valuable question clinicians could ask their patients was “what do you believe is going on?”, Langford said, characterising her role as one of partnership, validation, empowerment and promotion of the self-efficacy of her patients.

She also reflected on the importance of language and beliefs, and of educating patients about their pain, which she described as an ethical imperative.

This was a theme picked up strongly by Associate Professor Christina Bryant, a psychologist who offered some startling statistics and insights into living with chronic pelvic pain.

About half (48.6%) of the women in one study had experienced physical or sexual abuse, and one-third screened positive for post-traumatic stress disorder, Bryant said, with the odds also greatly increased of substance use (4.6x) and mood disorders (2.3-2.7x), with another study showing 86% had depression (compared with 38% of controls).

Chronic pelvic pain came at significant personal cost, Bryant said, with consequences for employment, social and intimate relationships, self esteem and parenting abilities.

Professor Sonia Grover, a specialist in paediatric gynaecology, painted a similar picture on chronic pelvic pain in her presentation on caring for vulnerable populations (see tweets in this thread).

Understanding and managing chronic pelvic pain was crucial given how common it was, affecting the same proportion of the population as back pain, she said.

Among adolescents, it had been found to have more significant impacts on quality of life than juvenile arthritis or cystic fibrosis, Grover said.

She offered some advice for clinicians (below) and reminded them not to forget their trans patients (read our story on trans health from #RANZCOG19).

Multidisciplinary approaches

Bryant said chronic pelvic pain patients tended to feel misunderstood by their treating doctors, isolated and alone, and became fixated on the idea that the next test or investigation would be “the one” to solve their problems.

Though there was usually a strong psychological element to their experience of the pain, they often resisted attempts to address these, Bryant said.

While there wasn’t much evidence for the efficacy of any one approach, including CBT, Bryant said there was some support in the research for multidisciplinary management, while mindfulness was emerging as a promising strategy.

For treating teams, a thorough pain history with an emphasis on functional impairment, beliefs, goals and coping strategies was essential, Bryant said, along with inquiring about a patient’s psychological and trauma history. She also stressed the role of patient education.

In a panel session to conclude the plenary, As-Sanie cautioned against an undue emphasis on trauma, describing it as just one piece of the puzzle and counselling colleagues to begin with symptoms.

Bryant echoed this warning, saying trauma was incredibly skilled and complex work and “you don’t want to entrust your trauma to just anyone”.

Professor Peter Rogers, who has worked in endometriosis research for almost 30 years, said O&G had – as a specialty – “dropped the ball” on endometriosis for too long, and it had only been through the dovetailing of patient activism and political will that progress was now being made.

He said data collection (“we can’t talk sensibly about the scope of the problem”), detection (the “holy grail” of which would be a non-invasive test or marker), and management (“to put it bluntly, we don’t know what we are doing”) were priority areas for research.

Read the full Twitter thread from the pelvic pain session.

• Stay tuned for our next report from #RANZCOG19 on the transvaginal mesh scandal.


This story is the latest in our #RANZCOG19 series from Amy Coopes, who attended the 2019 RANZCOG ASM in Melbourne for the Croakey Conference News Service.

Bookmark this link for the rest of our stories.

Leave a Reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.

Search by: Categories or tags