CPP is a common condition, with one study indicating that the monthly prevalence and incidence rates of CPP to be 2.2% and 1.6%, respectively [7]. In large nonclinical populations, prevalence rates are higher (approximately 14–24%) [8, 9]. Many studies have been conducted to assess the relationship between SA and CPP. Although the characteristics and quality of the studies vary substantially (e.g., differing CPP and SA diagnoses, control group issues), most using univariate analyses report an increased risk of CPP among women with a history of SA, and those studies using multivariate analyses indicate a more complex relationship between abuse, psychological distress, and chronic pain. The assessment of the timing and severity of SA has only been recently added to the empirical literature in attempts to further clarify the characteristics of SA that may be associated with CPP.

Univariate analyses were used in most of the studies assessing the association between SA (and, in some cases, physical abuse [PA]) and CPP. Two reported on patients seeking general gynecologic care [10, 11], and although both found SA to be associated with CPP, one did not find an association between CPP and PA [10]. Several reports compared women with CPP to pain-free control women, and all except one [12] reported an increased history of SA among those with CPP compared to controls [13–17].

Patients with CPP were compared to another pain group and with pain-free control women in several studies using univariate analyses [18–23]. In five of the six studies, SA was more commonly seen in the CPP group compared to the other chronic pain group and to the pain-free controls. Findings related to PA vary. Although Walling et al. [20] and Reed et al. [23] found PA to be associated with CPP compared to the other pain group and controls, no differences were found in another study [18]. Lampe et al. [21] found that PA differed between the two pain groups (which did not differ from each other) and the control group.

Despite proof of an association between SA and CPP, questions remain regarding whether this association is direct or related to confounding risk factors. Three studies used multivariate analyses to address the interrelationship of SA, PA, psychological outcomes, and CPP. Walling et al. [24] used multiple regression analysis to compare women with CPP, chronic headache, and pain-free control women. They found that SA was associated with depression, anxiety, and somatization, but this association disappeared when sociodemographic variables, chronic pain status, and childhood PA were taken into account. Alternatively, childhood PA predicted all three psychological variables (depression, anxiety, somatization) in this analysis. Poleshuck et al. [25] found that SA and PA were associated with psychological distress and anxiety among women with CPP, with PA also being associated with depression and somatization. However, in the multivariate analyses, PA, not SA, was independently associated with psychiatric outcomes.

Lampe et al. [26] modeled the relationship between SA, PA, depression, stressful life events, and chronic pain among women with CPP, low back pain, and pain-free controls. Severe childhood SA was associated with CPP (although childhood SA in general was not) and depression. Chronic pain was associated with childhood PA, stressful life events, and depression. Their model suggested that severe childhood SA was associated with chronic pain via its relationship to childhood PA, stressful life events, and depression, rather than via a direct relationship to chronic pain. These results suggest that the relationship between SA and chronic pain may be mediated by other variables (e.g., PA, depression).

IBS is a common cause of lower abdominal/pelvic pain, and due to marked symptom overlap, some suggest that IBS and CPP are a single clinical syndrome [27]. Even when considered separately, women diagnosed with CPP often have IBS [28, 29]. In a large survey study, 30% of women with CPP reported also having been diagnosed with IBS [3].

Of patients with IBS, 40–58% report childhood or adulthood SA and PA [27]. Talley et al. [30] found that patients with IBS were more likely (43.1%) to report SA as compared with 19.4% of those without IBS, and later replicated these findings with respect to childhood SA only [31]. Further, Drossman [32] compared patients with IBS to those with inflammatory bowel disorder (IBD; a syndrome with similar symptoms, but with an organic diagnosis), and found rates of SA and/or PA of 53% among women with IBS compared to 36% of women with IBD. Similar findings were reported by Walker et al. [33].

Among patients with IBS, IBD, or other gastrointestinal (GI) disorders, those with IBS are more likely to report higher rates of childhood SA (37.9%) than those in the other two groups (9.1% and 11.6%) [34]. Creed et al. [35] found that among those with severe IBS symptoms who were undergoing psychological treatment,12.1%reported a history of rape and 10.9% reported forced, unwanted touching. Those with a history of SA were more impaired on pain and physical functioning measures, but they were also more likely to improve with psychological treatments than those without such a history.

Some researchers have tested the belief that SA leads to increased rectal sensitivity to distention. Ringel et al. [36] assessed rectal distention pain thresholds in IBS patients and found that those with a history of severe SA had higher, rather than lower, thresholds for rectal pain and urge to defecate, disproving this theory. Guthrie et al. [37] attempted to identify subgroups of patients with severe IBS who were nonresponsive to conventional therapies based on measures of rectal sensitivity, psychological symptoms, and bowel symptoms. They found that SA history was associated with an increased number of doctor visits and psychiatric problems, interpersonal difficulties, and unemployment, but not with differences in sensitivity.

Leserman et al. [38] evaluated the severity of abuse and its relationship with outcomes among participants with GI symptoms. Of 239 women, 66.5% reported a history of SA and/or PA. Those with a history of SA had more pain, nongastrointestinal somatic symptoms, disability days, surgeries, psychiatric distress, and function disability; similar findings were seen with PA. Age at first abuse and multiple versus single episodes were not associated with differences in outcomes.