Abstract
This study examines psychological aspects of pelvic pathology with specific reference to endometriosis, a gynaecological disease where tissues like the endometrium (tissues that lines the inside of the uterus) are found outside the uterus. Endometriosis is a cause of pelvic pain, excessive bleeding and infertility. The first aim of the study was to evaluate the hypothesis that patients with endometriosis have a different socio-demographic and psychological profile from other gynaecological patients. A second aim was to evaluate the hypothesis that psychological factors are more important than disease severity in predicting pain experienced. A third aim was to evaluate the hypotheses that psychological factors predict pain outcome and that reason for referral (pain or infertility) influences psychological adjustment subsequent to treatment by laser surgery. The results did not support the hypothesis that endometriosis patients in comparison to patients with other pelvic pathology would be of higher socio-economic status. Endometriosis patients were found to be more anxious than other pelvic pathology patients, although there were no other between group differences. Socio-demographic factors were also found to influence pain reporting and, in the case of endometriosis, these factors were better predictors than the severity of the disease. Subsequent to treatment by laser surgery, there was a short-term improvement (three month follow-up) in both the psychological state and pain experience for both endometriosis and other pelvic pain patients, although a similar improvement was evident for an untreated control group. Both treated and control groups showed a longer term increase (one year follow-up) in pain ratings which returned to pre-treatment levels. Given the possibility that different referral groups (pain, infertility, and both pain plus infertility patients) attach differing meaning to laser laparoscopy, it was hypothesised that infertility patients would be more anxious but with less evidence of psychopathology in comparison to the pain group prior to laparoscopic surgery. Post-surgery and in the short-term, pain reduction was expected to be associated with decreased pathology for the pain group. Contrary to the hypothesis, pelvic pain patients, whether or not this is accompanied by infertility, obtained higher anxiety scores in comparison to the infertility group both pre- and post-treatment. Pain reduction for both pain groups was associated with a reduction in psychopathology. These findings are discussed together with their implications and recommendations for future work.