Chronic pelvic pain and pain at hysteroscopy in women with chronic endometritis

Investigation of chronic pelvic pain (CPP) is a challenging issue for clinicians. Chronic endometritis (CE) is a subtle condition that can cause CPP. This prospective, observational study estimated the prevalence of CPP in women in whom hysteroscopy showed a CE; as secondary endpoint the study aimed at evaluating whether condition of CE is relatd to higher discomfort at hysteroscopy. 1104 women undergoing hysteroscopy were asked whether they suffer of CCP. Presence of symptomatology was correlated to hysteroscopic and pathological findings. Chronic endometritis at hysteroscopy was confirmed by histology in 77% of cases and it was the only condition significantly associated with CPP. Compared to other women those in whom CE was demonstrated complained of greater pain at hysteroscopy and in 2 cases showed a vasovagal reaction. Chronic endometrits can be reliably detected at hysteroscopy and it is significantly associated with CPP. Positive anamnesis for CPP is a risk factor for pain and vasovagal reaction at hysteroscopy even by using atraumatic technique; CPP should be ruled out before performing hysteroscopy in order to paln adequate analgesic treatment and operative setting.