Knowledge and expertise in managing pain varies enormously between countries and between clinicians. In many European countries, a GP referral to consult a specialist is not required in gynaecology and pain management. In these countries patients have access to a consultant of their choice. In some countries, patients have great difficulty in accessing such services and expertise. Research in the UK indicates that patients seen in secondary care for long term pelvic pain are just the tip of the iceberg (Zondervan, BJOG, 1999). In the UK, undergraduates in medical training generally receive less than four hours training in managing pain. How can pain which is so important to the patient experience be such a low priority?

In many countries ultrasound examinations are carried out by the treating consultant, whereas in others, the consultant is dependent on the expertise of the radiologist who may not be experienced in pelvic pathology. MRI imaging expertise has advanced considerably and greater use is made of such expertise in some European countries than in others. This may have implications for diagnostic services and the way they are organized.
In 2006 an internet patient survey was carried out in France, the USA and the UK on access to services and quality of life for those with chronic pelvic pain. The survey indicated that patients have access to a very limited range of treatments and that many treatments are of little benefit. However patients in countries that had access to treatment in interdisciplinary teams found this beneficial. Patients who had access to specialized physiotherapy felt that this was helpful. However patients report that physiotherapy is much harder to access in some countries than in others. Countries which have easier access to physiotherapists with experience in pelvic pain include the USA, France and Germany. European citizens can seek care in another Member State in certain circumstances. The European court’s rulings have developed the following principles:

• Any non-hospital care to which a person is entitled in their own Member State, they may also seek in any other Member state without prior authorization, and be reimbursed up to the level of up to the level of reimbursement provided by their own system.

• Any hospital care to which they are entitled in their own Member State they may also seek in any other Member State provided they first have the authorization of their own system. This authorization must be given if their system cannot provide them care within a medically acceptable time limit considering their condition. They will be reimbursed up to at least the level of reimbursement provided by their own system.