Exploring the acceptability of a diagnostic laparoscopy in women with chronic pelvic pain - a triphasic study.


Chronic pelvic pain (CPP), defined as persistent pain perceived to be originating in pelvic structures and lasting for a period of more than six months, is one of the most common chronic pain problems experienced by women (1). CPP can be associated with several gynaecological and non-gynaecological conditions (1-4).

Psychosocial factors have long been considered significant in understanding an integrated picture of complex chronic pain conditions, including CPP (5,6). Pain-related distress and the emotional consequences of living with persistent pain can have debilitating and marked effects on an individual’s quality of life. Hence, it is little surprise that women with CPP often report depression, anxiety and reduced sexual function (6).

Many young women undergo diagnostic laparoscopy to diagnose the existence/absence of causative factors for their CPP (6) with more than a third having no cause for their pain found, a negative laparoscopy. Subsequently, psychologically distressed women, with no diagnosis, often become ‘stuck in the revolving door’ of gynaecology services and enter a disheartening and costly cycle of reinvestigation. There is rarely a clear or holistic care pathway for the majority of women with CPP resulting in fragmented care.


Objective 1/Phase 1: Online questionnaire to explore the views of women (with and without CPP) on the acceptability of a diagnostic laparoscopy to diagnose pathology related to CPP. Patient and public involvement and Endometriosis UK will be important in the development and refinement of this q

Objective 2/Phase 2: A qualitative study; Individual semi-structured interviews, guided by phase 1 outcomes, with women diagnosed with CPP to further explore their views on a diagnostic laparoscopy. The interview topic guide will be influenced by the findings from the first phase.

Objective 3/Phase 3: A longitudinal questionnaire study (3 time points), pre and post diagnostic laparoscopy and 3 months after laparoscopy. This phase will include validated psychometrics, including; the Decision regret scale (7), Hospital Anxiety and Depression Scale (8), Pain Catastrophising Scale (9), Pain Self-efficacy Questionnaire (10) and the Illness perception questionnaire (11).

Objective 4/Phase 4: The development of a care pathway (based on phases 1-3) that assists in the stratification of women with CPP based on predictive psychological factors; allowing multidisciplinary care, holistic assessment and appropriate mechanisms for timely inter-speciality referrals to chronic pain services.  


Women with CPP attending the gynaecological department are currently not being treated holistically which is, in turn, leading to a repetitive cycle of repeat operations and attendances at the emergency room and outpatient department. The cycle needs to be broken and rounded care ensuring mental health morbidity is undertaken. We have the possibility of, by putting together an individualised tailored approach to women at the start of the journey, could mean they do not continue on a path of further health seeking and diagnosing behaviour and appropriate treatment plans are implemented.

Application Process

Candidates wishing to apply should please send the following documents as a single PDF file to 

1. Cover letter

2. CV

3. Names and contact details of two academic references


Open to EU/UK applicants

Funding information

Funded studentship

This Scholarship is for UK [home] students only and has a financial package including: annual stipend at the UKRI rate [currently £17,668 per annum for academic year 2022-23] and student fees. Overseas students are eligible to apply if they can cover the difference in UK and Overseas tuition fees, the costs of their student visa, NHS health surcharge, travel insurance and transport to the UK, as these are excluded from the funding.




1. RCOG. The Initial management of chronic pelvic pain. In Green Top Guideline No. 41; Royal College of Obstetrics and Gynaecology: London, UK, 2012.
2. Abercrombie, P.D.; Learman, L.A. Providing holistic care for women with chronic pelvic pain. J. Obstet. Gynecol. Neonatal. Nurs. 2012, 41, 668–679.
3. Chao, M.T.; Abercrombie, P.D.; Nakagawa, S.; Gregorich, S.E.; Learman, L.A.; Kuppermann, M. Prevalence and use of complementary health approaches among women with chronic pelvic pain in a prospective cohort study. Pain Med. 2015, 16, 328–340.
4. Rosenbaum, T.Y.; Owens, A. The role of pelvic floor physical therapy in the treatment of pelvic and genital pain-related sexual dysfunction (CME). J. Sex. Med. 2008, 5, 513–523.
5. Till, S.R.; As-Sanie, S.; Schrepf, A. Psychology of chronic pelvic pain: Prevalence, neurobiological vulnerabilities, and treatment. Clin. Obstet. Gynecol. 2019, 62, 22–36. Trutnovsky, G.; Plieseis, C.; Bjelic-Radisic, V.; BertholinyGalvez, M.C.; Tamussino, K.; Ulrich, D. Vulvodynia and chronic pelvic pain in a gynecologic outpatient clinic. J. Psychosom. Obstet. Gynaecol. 2019, 40, 243–247.
6. Tempest N, Efstathiou E, Petros Z, Hapangama DK (2020) Laparoscopic Outcomes after Normal Clinical and Ultrasound Findings in Young Women with Chronic Pelvic Pain: A Cross-Sectional Study. J Clin Med;10;9(8):2593.
7. Brehaut JC, O'Connor AM, Wood TJ, Hack TF, Siminoff L, Gordon E, Feldman-Stewart D. Validation of a decision regret scale. Med Decis Making. 2003 Jul-Aug;23(4):281-92.
8. Zigmond AS Snaith RP. The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand 1983;67:361–370.
9. Sullivan MJL, Bishop SR, Pivik J. The Pain Catastrophizing Scale: Development and Validation. Psychol Assess, 1995; 7(4): 524-32.
10. Nicholas MK. The pain self-efficacy questionnaire: taking pain into account. European journal of pain. 2007 Feb 1;11(2):153-63.
11. J Weinman, KJ Petrie, R Moss-Morris, R Horne. The Illness Perception Questionnaire: a new method for assessing the cognitive representation of illness. Psychol Health, 11 (1996), pp. 431-445.