title: Management of chronic pelvic pain additional to tubal sterilization.
abstract: OBJECTIVE
  A case series is presented to illustrate the dilemma in management of women with Chronic Pelvic Pain (CPP) additional to a tubal sterilization.
  
  
  METHODS
  Between January 1999 and June 2007, five women consulted the Department of Gynecology for CPP additional to tubal sterilization with Filshie Clips (FCs). A biopsychosocial approach of the complaint was offered and laparoscopic removal of the clips was performed in all cases. The effectiveness of this management was assessed by a personal interview and a retrospective chart review.
  
  
  RESULTS
  Two of the five patients refused an exploration of psychosocial factors possibly contributing to or maintaining the pain. During laparoscopic removal of the Filshie Clips no additional pathology was noted. At follow-up four women declared to have benefited from the removal procedure.
  
  
  CONCLUSIONS
  If women present with CPP additional to sterilization with FCs in the absence of obvious pathology, gynecologists have to pay attention to the possibility of underlying psychosocial factors to this complaint. However, this attention can be in conflict with the woman's conviction that only removal of the clips will alleviate her pain. In that case, laparoscopic removal might be a component of the management.
authors.affiliation: Department of Gynecology, Leiden University Medical Centre, The Netherlands.
authors.forename: Ellen
authors.initials: E
authors.lastname: Hiemstra
authors.forename: Philomeen Tm
authors.initials: PT
authors.lastname: Weijenborg
authors.forename: Frank Willem
authors.initials: FW
authors.lastname: Jansen
mesh_terms: D000328:Adult; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy; D017699:Pelvic Pain / Q000601:surgery*; D013246:Sterilization, Tubal / Q000379:methods*; D016896:Treatment Outcome