A woman with significant chronic pelvic pain may benefit from a hysterectomy. However, the patient should be carefully evaluated with demonstrated failure of alternative therapies before the surgery is performed.


Confirmation - All of the following:

(1) No remediable pathology found on laparoscopic examination.

(2) Presence of pain for more than 6 months.

(3) Negative effect of the pain on the patient's quality of life.



(1) Desire to maintain fertility

(2) Known medical or psychological risks outweigh the benefits.


Actions prior to performing hysterectomy:

(1) Document failure of alternative therapies.

(2) Evaluate the urinary, gastrointestinal, neurological and musculoskeletal systems for possible sources of pain.

(3) Evaluate the patient's psychologic and psychosexual status for nonsomatic causes.

(4) Confirm the absence of cervical malignancy by cytology examination.


Alternative therapies: multidisciplinary, symptom-targeted which may include trials of one or more of the following, alone or in combination:

(1) oral contraceptives

(2) narcotic analgesics

(3) NSAIDs

(4) induced amenorrhea

(5) abdominal trigger point injection

(6) tricyclic antidepressants

(7) counseling

(8) lysis of adhesions

(9) nerve resection.


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