title: Cesarean section as a cause of chronic pelvic pain.
abstract: OBJECTIVE
  To determine if the history of cesarean section was associated with chronic pelvic pain, independent of the presence of other conditions such as pelvic adhesions, endometriosis, sequelae of pelvic inflammatory disease, leiomyoma and pelvic varices.
  
  
  METHODS
  Retrospective case-control study conducted on 199 patients consecutively admitted from January 1998 to January 2000, 116 of them submitted to laparoscopy for the diagnosis of chronic pelvic pain and 83 asymptomatic patients submitted to tubal ligation by laparoscopy. A logistic regression analysis was used to verify the association between chronic pelvic pain and the history of previous cesarean section.
  
  
  RESULTS
  In women with chronic pelvic pain, a history of cesarean section was observed in 67.2% of cases, adhesions in 51.7%, endometriosis in 33.6%, sequelae of pelvic inflammatory disease in 31.9%, leiomyoma in 6.9% and pelvic varices in 11.2%. In asymptomatic women, a history of cesarean section was observed in 38.5%, adhesions in 24.1%, endometriosis in 9.6%, sequelae of pelvic inflammatory disease in 4.8%, leiomyoma in 7.2% and pelvic varices in 3.6%. In a logistic model, chronic pelvic pain was associated with a history of cesarean section (O.R.=3.7), as well as with endometriosis (O.R.=8.5), sequelae of pelvic inflammatory disease (O.R.=10.5).
  
  
  CONCLUSIONS
  In the present study cesarean section was associated with chronic pelvic pain. This fact may be the cause of a public health problem in the coming years, due to the raised rates of cesarean section in Brazilian women.
authors.affiliation: Department of Gynecology and Obstetrics, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil.
authors.forename: E C S
authors.initials: EC
authors.lastname: Almeida
authors.forename: A A
authors.initials: AA
authors.lastname: Nogueira
authors.forename: F J
authors.initials: FJ
authors.lastname: Candido dos Reis
authors.forename: J C
authors.initials: JC
authors.lastname: Rosa e Silva
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D002585:Cesarean Section / Q000009:adverse effects*; D002908:Chronic Disease; D004715:Endometriosis / Q000150:complications; D005260:Female; D006801:Humans; D010535:Laparoscopy; D018231:Leiomyomatosis / Q000150:complications; D016015:Logistic Models; D008875:Middle Aged; D000292:Pelvic Inflammatory Disease / Q000150:complications; D017699:Pelvic Pain / Q000150:complications* / Q000175:diagnosis / Q000209:etiology*; D010388:Pelvis / Q000098:blood supply / Q000473:pathology; D012189:Retrospective Studies; D013246:Sterilization, Tubal / Q000379:methods; D000267:Tissue Adhesions / Q000150:complications; D014594:Uterine Neoplasms / Q000150:complications; D014648:Varicose Veins / Q000150:complications