[Medicolegal aspects of chronic pelvic and perineal pain]

Abstract

Objective: To review the medicolegal aspects of chronic pelvic and perineal pain.

Material and methods: The literature and the French Public Health Code were reviewed. The review of the literature was performed by searching the Medline database (National Library of Medicine). Search terms were either medical subject heading (MeSH) keywords (forensic medicine, legislation, pelvic pain, postoperative pain) or terms derived from the title or abstract. Search terms were used alone or in combinations by using the "AND" operator. The literature search was conducted from 1990 to the present time.

Results: Chronic pelvic and perineal pain raises a number of medicolegal issues: pain management is required by law, chronic pelvic and perineal pain can be a complication of certain surgical procedures and may be the subject of patient complaints, certain medical or surgical treatments of chronic pelvic and perineal pain do not have a marketing authorisation or scientific validation with a high level of evidence, which can have medicolegal implications. The French law of 4 March 2002 concerning patient rights and quality of the health care system defines a number of legal obligations. All physicians must comply with good professional practices as defined by the code of medical ethics and scientific knowledge. All surgeons are required to provide the patient with honest, clear and appropriate information about the risks of a proposed operation, especially about the possible risk of pain. It is also advised to provide the patient with a written document. All physicians must subscribe a professional civil liability insurance policy. Contraceptive vasectomy, that may be complicated by pain, is a particular case, subject to the French law of 4 July 2001, which requires the surgeon to provide the patient with written information and requires the patient to confirm his request for vasectomy in writing after a 4-month period of reflection.

Conclusion: The field of chronic pelvic and perineal pain comprises numerous and major medicolegal implications, requiring compliance with good clinical practice and legislation, especially the French law of 4 March 2002 concerning patient rights and quality of the health care system.