The role of laparoscopy in the evaluation of chronic pelvic pain: Pitfalls with a negative laparoscopy

Laparoscopic findings are negative in anywhere from 10% to 90% of women with chronic pelvic pain. When this occurs a woman is often told one or more of the following: (1) nothing is wrong; (2) the pain is in her head and she should see a psychiatrist; (3) she should have a neurolytic procedure, such as uterine nerve transection or presacral neurectomy; (4) the only thing that is left to do is a hysterectomy; or (5) nothing can be done and she must learn to live with the pain. Usually these statements are inappropriate, often stemming from the mistaken belief that laparoscopy represents the definitive diagnostic end point in the evaluation of a woman with chronic pelvic pain. It is important that gynecologists appreciate that laparoscopy is only one of many possible methods of evaluation and recognize ifs diagnostic limitations and pitfalls.