The American College of Obstetricians and Gynecologists outlined criteria that should be met before performing a hysterectomy for pelvic pain (150). They require at least 6 months of pelvic pain without any otherwise correctable pathology. When deciding on the surgical approach, consideration should be given to a vaginal or laparoscopic hysterectomy over an abdominal approach if there are no extensive adhesions expected or large uterine/fibroid size does not preclude it. There are many studies that confirm less morbidity and shorter hospital stays with vaginal compared with abdominal hysterectomies (151). A prospective study of abdominal versus vaginal versus laparoscopically assisted surgery did not find any statistical difference or worsening of outcomes of urinary or sexual function between the different approaches at 6 months (151).
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