Chronic pelvic pain: A different perspective

A different perspective of chronic lower abdominal pelvic pain, collision dyspareunia, and vulvodynia related to laxity in the uterosacral ligaments is presented. The syndrome presented is quite characteristic: low abdominal 'dragging' pain, usually unilateral, often right-sided, low sacral pain, deep dyspareunia, and postcoital ache, tiredness, and irritability. The pain has been demonstrated to be a referred pain. Injection of local anesthesia in the posterior vaginal fornix causes the pain to disappear temporarily. An initial cure rate of up to 80% has been reported following tensioning and reinforcement of the uterosacral ligaments, most recently with the tissue fixation system (TFS).