CHRONIC PELVIC PAIN: CHRONIC PELVIC PAIN: OUT OF SIGHT... OUT OF - - PowerPoint PPT Presentation

CHRONIC PELVIC PAIN: CHRONIC PELVIC PAIN: OUT OF SIGHT... OUT OF MIND OUT OF SIGHT... OUT OF MIND

Prof . Massimo Prof . Massimo Candiani Candiani Head Dept Obstetrics and Head Dept Obstetrics and Gynecology Gynecology

• Univ. Hospital San
• Univ. Hospital San Raffaele

Raffaele, Milan, Italy , Milan, Italy

2

The disease The disease

• ! "#$"
• !

3

Who Who’ ’s in charge? s in charge?

4

The disease The disease

• 1. There is often no consensus on the DEFINITION of

gynecological chronic pelvic pain

Diagnostic delay Diagnostic delay

!"#$%#&! #'%()#! #'# !**)%+$!,#')&+$*)% !#-*$)%.$/ */*$*$! #*!)%$#( (%%. !)0'#!*)%") *#! $(%+$#/! 1)##& #2

• 222(!% !#! $/*! %%#!"%/&#!&%

$!*$3(#! #!&*$0! % # "!#!4&! #'%+)#$%!*! %##)#% (%# *#*!&$-&)$#(& %! $(%% ##/*!&% 0%/*'!$!0*$!0 * (%/*'!%!&#*' !& *$$( *'! *$.* ( $ %/ (!&%

• *#$24

*'$#$

5

The disease The disease

• 2. There are different possible etiologies, ofter overlapping

and a poor correlation between symptoms and extent of underlying disease

Diagnostic delay Diagnostic delay

Laparoscopic gynecological findings during CPP investigation

5!,(

6

Diagnostic delay in relation to the dimension of DIE

#%)36#$#$7#$4

7

The patient The patient

• 1. Normalization of symptoms & Lack of education

Diagnostic delay Diagnostic delay

#%# & # &%&8 04 /&#!&%"!/%!#! (0 !%%

$$(#$4

#&& & & %

• 2. Frustration

8

The society The society Diagnostic delay Diagnostic delay

• 1. Menstruation as a ‘discrediting attribute’; fear of working

discrimination and prejudice

& %

• &

9

As a result As a result… … Diagnostic delay Diagnostic delay

9 20% see a gynecologist 9 10% other physician 9 1% mental health evaluation 9 70% …..see no one?

10

• 1. Normalization of symptoms

'& & % (!

• 2. Intermittent suppression of symptoms

with hormones

)#*+# !#"" ,

• 3. Lack of training

#&

• !!'
• !!

%# %& (!

*:!,

Diagnostic delay Diagnostic delay The healthcare professional The healthcare professional

11

*:!,

• 4. Therapeutic nihilism

Diagnostic delay Diagnostic delay The healthcare professional The healthcare professional

• !!%
• &
• (!

ESHRE Guidelines for the pelvic pain suggestive of endometriosis

; (/#$5)&!(<

13

What What’ ’s the delay? s the delay?

Author, year Estimated diagnostic delay (years) Wood et al, 1992 6 Hardfield et al, 1996 11.7 (US) 7.96 (UK) Dimowsky et al, 1997 4.6 Husby et al, 2003 6.7 !"#$%%&'( " #!

14

9 61% no diagnosis given by physician 9 39% diagnosis given 25% endometriosis 49% a non-cycle related gynecologic disorder (e.g. yeast infection or chronic PID 10% non-gynecologic disorder 16% other

Uncomfortable diagnosis Uncomfortable diagnosis

, #! 4 )*

15

Delay Delay’ ’s implications s implications

$%&'($%)*%+,-'*)./%01.%,'

16

Old patients, new challenges Old patients, new challenges

BOOSTING SIGHT & VISIBILITY

*,.2,%*-,%/ *,.,*3.'

• 114,*%*-,

2%*,*,+ +4*)./*,.'

.&&% / 0 1'&$*2234

'-*.*.' 2-''%/5

17

5 66#$6')$7#7"$8$$9!$-" ".'$$ 6$.)5$#(.8$6-.:$

Speed up! Speed up!

18

Thank You Thank You