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Abstract

Background:

Chronic pelvic pain (CPP) is often described as a multisystem pain condition, yet population-level evidence on adolescent antecedents is scarce. We examined whether healthcare encounters for gynecologic or reproductive morbidity during adolescence were associated with incident CPP in adulthood.

Methods:

In this population-based matched cohort study, we used linked administrative health data to identify individuals assigned female at birth who turned 18 years between Jan 1, 2008, and Jan 1, 2020. Exposed participants had at least one emergency department or inpatient encounter, or at least two outpatient encounters, for gynecologic or reproductive conditions between ages 10 and <18 years. They were matched 1:2 to unexposed participants by birth year, neighbourhood income quintile, and rurality. Follow-up began at the 18th birthday and continued until incident CPP, death, loss of health-insurance eligibility, or March 2025. Associations were estimated using cause-specific Cox models adjusted for adolescent comorbidity and healthcare utilisation.

Findings:

Among 466,560 matched individuals, 155,520 had adolescent gynecologic or reproductive morbidity, and 311,040 were unexposed. Before adulthood, exposed adolescents had higher rates of mental health diagnoses (46·0% vs 24·7%), non-pelvic chronic pain (30·2% vs 17·8%), gastrointestinal morbidity (59·0% vs 31·1%), and hospital admission (18·6% vs 7·2%), Incident adult CPP occurred in 46,014 exposed participants (29·6%) and 50,447 unexposed participants (16·2%). Cumulative incidence separated early and continued to diverge; by 5 years, it was 17·0% versus 7·6%, and by 10 years, 28·0% versus 14·9%. After adjustment, adolescent gynecologic or reproductive morbidity was associated with higher hazards of adult CPP (aHR 1·41, 95% CI 1·39–1·43).

Interpretation:

Adolescent gynecologic and reproductive morbidity identifies a large population at increased risk of adult CPP. These findings support earlier recognition and integrated assessment of adolescent pelvic, menstrual, and reproductive symptoms before chronic pain trajectories become established.