{"paper_id":"02cfbbb2-1dd0-42bc-88ed-b5997ec1a9a6","body_text":"International Journal of Frontiers in Medicine \nISSN 2706-6819 V ol.5, Issue 5: 84-91, DOI: 10.25236/IJFM.2023.050515 \nPublished by Francis Academic Press, UK \n-84- \nProgress of Chinese and Western Medicine Research \non Chronic Pelvic Pain in Gynecology \nXinling Qin1,a, Hongli Zhu2,b,* \n1Shaanxi University of Chinese Medicine, Xianyang, 712046, Shaanxi, China \n2Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, 712000, Shaanxi, China \na357104378@qq.com, b15909104459@163.com \n*Corresponding author \nAbstract: Chronic pelvic pain is a syndrome of non -cyclical pelvic pain caused by a variety of causes \nlasting more than 6 months with organic or functional causes, which involves a wide range of systems, \nunclear etiology, complex species, high incidence, difficult diagnosis, and poor treatment, and \nseriously affects the quality of life of patients. Gynecologic factors are common causes among many \netiologies. This article reviews the etiology, diagnosis and treatment of chronic pelvic pain caused by \ngynecological factors, with a view to providing a certain reference basis for the clinical diagnosis and \ntreatment of chronic pelvic pain. \nKeywords: Gynecology; chronic pelvic pain; endometriosis; pelvic adhesions \n1. Introduction \nChronic pelvic pain (CPP) is a symptom, not a diagnosis, and refers to a syndrome of non- cyclical \npelvic pain of organic or functional causes lasting more than 6 months caused by various reasons, and \nis a common symptom in women of clinical reproductive age, with the main symptoms being lower \nabdominal cramping, pain and lumbosacral pain, which intensifies before and after exertion, sexual \nintercourse and menstruation \n[1]. Chronic pelvic pain involves a wide range of systems, has an unclear \netiology, is complex, has a high incidence, is difficult to diagnose, and has poor therapeutic effects, and \nseriously affects the physical and mental health of women. And gynecologic CPP accounts for about 90% \nof CPP, so the diagnosis of gynecologic CPP is a major challenge for all gynecologists [2]. Common \ngynecologic factors causing chronic pelvic pain include gynecologic pelvic inflammatory diseases, \nendometriosis, pelvic venous stasi s syndrome, and pelvic adhesions [3]. Because of the insidious onset \nand complex etiology of chronic pelvic pain, current noninvasive examination methods are of limited \nvalue for definitive etiological diagnosis, making diagnosis more difficult and consequently treatment \nrelatively tricky [4]. Understanding the etiology of chronic pelvic pain due to gynecological factors can \nhelp to correctly guide the treatment of this disease, improve the therapeutic effect and improve the \nquality of life of patients. In this paper, we review the etiology, diagnosis, and treatment of chronic \npelvic pain due to gynecological factors in order to provide some reference basis for the diagnosis and \ntreatment of chronic pelvic pain in clinical practice. \n2. Etiology \nAbout 90% of chronic pelvic pain is caused by gynecological factors (Table 1), with insidious onset, \nlow consultation rate, complex etiology, and most noninvasive diagnostic methods fail to clarify the \netiology, and the development of laparoscopic techniques has provided a deeper understanding of the \netiology of gynecological CPP\n[2]. Among them, chronic pelvic inflammatory disease accounts for about \n23%-30% of CPP, endometriosis accounts for about 25% -38%, followed by pelvic venous stasi s \nsyndrome and pelvic adhesions[5]. \n \n \n \n \n\nInternational Journal of Frontiers in Medicine \nISSN 2706-6819 V ol.5, Issue 5: 84-91, DOI: 10.25236/IJFM.2023.050515 \nPublished by Francis Academic Press, UK \n-85- \nTable1: Partial gynecological diseases \nDisease Clinical presentation Diagnostic methods \nPelvic inflammatory \ndiseases \nLower abdominal pain, aggravated by exertion \nor menstruation, etc. \nGynecologic \nexaminations \nEndometriosis \nSecondary dysmenorrhea, progressive \nworsening, menstrual disorders, deep \nintercourse pain, etc. \nLaparoscopy \nPelvic congestion \nsyndrome \nIrregular pain sites, congestive dysmenorrhea, \ndeep intercourse pain, post-coital pain, and \npain relief after prolonged standing \nPelvic Venography \nPelvic adhesions Cramping and pain in the lower abdomen, \naggravated by exertion or menstruation, etc. Laparoscopy \n2.1. Pelvic inflammatory diseases \nPelvic inflammatory disease is a common infectious disease in non -pregnant women and a major \ncause of pelvic pain, with a wide variety of pathogenic microorganisms and often associated with \nmixed infections, varying clinical symptoms, signs and severity, h igh diagnostic uncertainty, and \nirregular treatment, resulting in pelvic inflammatory disease that cannot be cured in a timely manner, \nhas a high recurrence rate, and may cause other complications such as infertility. The pathogenesis is \nnot yet fully unde rstood, and may be related to inflammation causing abnormalities in the uterus, \nfallopian tubes, and ovarian travel, and the inflammatory response stimulates pelvic congestion and \ncauses chronic pelvic pain \n[3]. Pelvic inflammatory disease often occurs aft er childbirth, infection \nfollowing miscarriage or abortion, and impure sexual intercourse. The pain is a persistent dull or \nhidden pain, swelling, cramping or lumbosacral cramping in the lower abdomen, aggravated by \nexertion or menstruation, and often acco mpanied by increased leucorrhea and excessive menstruation. \nDiagnosis: gynecologic examination may palpate a striated thickening or a rasping pattern in one or \nboth adnexal areas with mild pressure pain; in severe cases, a cystic mass of variable size and irregular \nshape may be palpated in the bilateral adnexal area or the posterior aspect of the uterus, which is \ninactive and mostly has pressure pain \n[2]. \n2.2. Endometriosis \nEndometriosis (EMS) is a gynecological condition caused by active endometrial cells in a woman's \nuterus that are implanted in a location other than her endometrium [6]. The vast majority of patients with \nendometriosis have varying degrees of chronic pelvic pain. The main manifestation of endometriosis is \nsecondary dysmenorrhea, which is p rogressively worse and often associated with menstrual disorders, \ndeep intercourse pain, infertility, and intestinal or urinary tract symptoms. Endometriosis is a pelvic \ninflammatory process that causes a more complex mechanism of pain production, and nerve conduction \nis thought to be an important cause of chronic pelvic pain due to endometriosis \n[3]. \nThe causes of chronic pelvic pain due to endometriosis [7] may be: (1) EMS patients mostly have \npelvic adhesions, and their adhesion sites may form fibrous fasciculations that restrict the movement of \ntheir pelvic organs, resulting in pulling pain when they move. (2) The nerve fibers in the lesion sites of \nEMS patients produce impulse conduction, which can cause pain in their areas innervated by that nerve. \n(3) The pain caused by EMS caused by dysmenorrhea or painful intercourse can lead to central sensory \nhypersensitivity in patients, increasing their sensitivity to pain.  \nDiagnostic methods: (1) Cystic, inactive masses with light pressure pain in close adhesion to the \nuterus are palpated at one or both adnexa of the uterus on gynecological examination; painful nodules \nare palpated in the fundic ligament, lower pa rt of the posterior uterine wall, and vaginal rectal septum \n[2]. (2) Laparoscopic diagnosis is the gold standard for the diagnosis of endometriosis, and blood \nCA125 and ultrasonography assist in the diagnosis. \n2.3. Pelvic congestion syndrome  \nPelvic conges tion syndrome (PCS), also known as ovarian venous syndrome, is a gynecological \ndisorder caused by poor blood flow from the pelvic veins, filling and stasis of the pelvic veins. Pelvic \ncongestion syndrome is one of the main factors causing chronic pelvic pain. Premenopausal women are \nthe main group of patients with pelvic congestion syndrome, which suggests that the occurrence of \n\nInternational Journal of Frontiers in Medicine \nISSN 2706-6819 V ol.5, Issue 5: 84-91, DOI: 10.25236/IJFM.2023.050515 \nPublished by Francis Academic Press, UK \n-86- \npelvic congestion syndrome may be related to the decrease in the level of sex hormones in women [6]. \nPelvic congestion syndrome is  mainly characterized by irregular pain sites, congestive dysmenorrhea, \ndeep intercourse pain, postcoital pain, and pain relief after prolonged standing. Diagnostic methods: (1) \nphysical examination: mild deep pressure pain in the lower abdomen is the only  positive sign in the \nabdominal examination of pelvic venous stasis syndrome; (2) gynecological examination signs are \nmostly inconspicuous and easily misdiagnosed as chronic pelvic inflammatory disease; (3) ultrasound \nis not very sensitive; (4) laparoscopi c examination without inflammatory manifestations and organic \nlesions, with a slightly large spherical uterine body with a purplish -blue, florid surface and thickened \npelvic veins like earthworms or in clusters. (5) Pelvic venography reveals dilated pelvic  veins with \nslow evacuation of contrast, which is the main method to confirm the diagnosis [2]. \n2.4. Pelvic adhesions \nPelvic adhesions (pelvic adhesions) include uterine adhesions, fallopian tube adhesions, and ovarian \nand fallopian tube adhesions. Pelvic adhesions are a common postoperative complication in patients \nundergoing pelvic surgery and are one of the main causes of chronic pelvic pain. A study by J. Wei [8] \nfound that pelvic adhesions are the third cause of chronic pelvic pain in addition to endom etriosis and \ninflammatory pelvic diseases. A related study pointed out that performing pelvic surgery (especially \nopen surgery) can cause damage to the patient's peritoneum, which can lead to fibrosis of the \nperitoneum and the formation of adhesions betwee n the peritoneum and the surrounding organs, \ncausing strain and irritation to the surrounding organs, which can lead to chronic pelvic pain. The \nadhesions cause damage to the organs and nerve impulses are transmitted to the central nervous system, \nwhich innervates the corresponding dermatomes to produce pain. Clinical information on the incidence \nof pelvic adhesions causing chronic pelvic pain is high, but it is not clear whether there is a causal \nrelationship with the occurrence of chronic pelvic pain \n[3,6]. \n2.5. Chronic pelvic pain after gynecological surgery \nSome studies [9] have suggested that injury to the inferior abdominal hypogastric plexus caused by \nchildbirth, gynecological laparoscopic surgery, cesarean section, pelvic inflammatory diseases, and \ntrauma and the resulting nerve reconstruction can lead to chronic pelvic pain by the following \nmechanisms( Figure 1) [10]: (1) the female genital organs are innervated by nerves originating from the \npelvic plexus and inferior abdominal plexus; (2) nocicepti ve nerve fibers distributed in the uterus and \nvagina, whose nerve impulse generation and the nociceptive nerve fibers in the uterus and vagina are \ninfluenced by the reproductive state of the reproductive organs; (3) nerve impulses interact in different \nnerve conduction pathways; (4) the pelvic organs have the same nerve conduction pathways, and the \nfunctional states of different organs can interact with each other. \n \nFigure 1: Possible mechanisms of nerve injury and reconstruction leading to chronic pelvic pain \n2.6. Others \nUterine adenomyosis is the invasion of endometrium and its interstitial cells into the myometrium, \nforming foci locally. During menstruation, intermyometrial lesions release large amounts of \nprostaglandins and inflammatory mediators that s timulate or damage nerve endings, and massive \nbleeding from intermyometrial lesions can also stimulate abnormal contractions of the uterus and \ndestroy uterine smooth muscle cells, resulting in chronic pelvic pain [11]. Chronic pelvic connective \ntissue inflammation is mostly secondary to severe cervicitis, which mainly manifests as congestion and \n\n\nInternational Journal of Frontiers in Medicine \nISSN 2706-6819 V ol.5, Issue 5: 84-91, DOI: 10.25236/IJFM.2023.050515 \nPublished by Francis Academic Press, UK \n-87- \nedema in the acute phase, and after developing as chronic inflammation the bilateral uterosacral \nligaments and parametrial tissues are significantly thickened, whic h can cause the uterus to shift or \ndeviate to one side, or restrict anterior and posterior movements, and patients experience lumbosacral \nor lower abdominal distension and pain, and chronic pelvic pain occurs \n[12]. In addition, uterine smooth \nmuscle tumors and pelvic organ prolapse can likewise cause the development of chronic pelvic pain [3]. \nIn addition hormonal changes, social factors, abuse and negative psychological traits are all associated \nwith the development of chronic pelvic pain, but the exact me chanisms need to be further investigated \n[13]. \n3. Treatments \n3.1. Western medicine \nCurrently, for the treatment of chronic pelvic pain, western medical treatment includes \npharmacotherapy, surgery, physical therapy and psychotherapy. Drug treatment is mainl y based on \nanalgesic, hormonal drugs and psychotropic drugs. Since there are no specific therapeutic drugs for \nchronic pelvic pain, treatment methods are often difficult to completely improve the clinical symptoms \nof patients. (Figure 2) \n \nFigure 2: Treatments \n3.1.1. Pharmacological treatment \n3.1.1.1. Non-steroidal anti-inflammatory drugs \nNon-steroidal anti -inflammatory drugs are commonly used as clinical analgesics, and the \ncommonly used drugs include aspirin, diclofenac sodium, indomethacin, acetami nophen, etc. These \ndrugs have the advantages of short half -life cycle, repeated use and light side effects, and clinical \nadverse effects are mainly gastrointestinal discomfort. In the clinical treatment of chronic pelvic pain, \ndifferent NSAIDs are administ ered according to the patient's pain level in a stepwise manner, and \ndifferent NSAIDs are selected in a targeted manner, and their combined application with opioids can \nenhance the analgesic effect of opioids and reduce the drug dosage\n [14]. \n3.1.1.2. Hormonal drugs \nClinically used hormonal drugs include progestins, gonadotropin- releasing hormone agonists, and \nlevonorgestrel intrauterine extended -release systems. Gonadotropin -releasing hormone agonists can \nrelieve pain by adjusting estrogen in a low state via the pituitary gland. Treatment of patients with \nchronic pelvic pain with progestins or estrogens may inhibit their ovulation, reduce the incidence of \nspontaneous uterine contractions, and block their prostaglandin synthesis, which in turn may relieve \ntheir pain [6]. The clinical adverse effects are possible breakthrough bleeding and breast tenderness. \n3.1.1.3. Psychotropic drugs \nPatients suffering from chronic pelvic pain are more likely to suffer from depression and anxiety, \nand the quality of sleep will  be reduced when the condition worsens. Such patients can take oral \npsychotropic drugs to relieve depression and other problems. \n3.1.2. Surgical treatment \n3.1.2.1. Removal of the lesion  \nChronic pelvic pain caused by endometriosis combined with pelvic mass es should be treated \nsurgically to remove the lesions visible to the naked eye and reconstruct the pelvic anatomy [15]. \nMeanwhile, surgical treatment of chronic pelvic pain caused by gynecological diseases such as uterine \n\n\nInternational Journal of Frontiers in Medicine \nISSN 2706-6819 V ol.5, Issue 5: 84-91, DOI: 10.25236/IJFM.2023.050515 \nPublished by Francis Academic Press, UK \n-88- \nfibroids and ovarian tumors can significantly improve chronic pelvic pain and reduce patients' suffering. \nAmong them, conservative surgery, which involves removing as much of the lesion as possible and \npreserving its uterus and adnexa, the more completely the lesion is removed, the more si gnificant the \npain relief and the lower the recurrence rate, and this method is suitable for patients with reproductive \nneeds [16]. \n3.1.2.2. Adhesionolysis \nAdhesionolysis is recommended only after comprehensive treatment has failed, in order to \neliminate or relieve pelvic pain [17]. However, adhesiolysis is prone to recurrence of pelvic adhesions, \nso laparoscopic adhesiolysis is considered for the treatment of chronic pelvic pain caused by severe \npelvic adhesions in clinical practice [3]. \n3.1.2.3. Nerve block  \nNerve block is the excision of the nerves of the anterior sacral and uterosacral ligaments, and both \nexcisions are used to block pain transmission for t he treatment of chronic pelvic pain [3]. Laparoscopic \nuterine nerve removal in patients with chronic pelvic pain can cut the uterosacral ligaments on both \nsides of the uterus, blocking the nociceptive nerve conduction pathways, which in turn can provide pain \nrelief\n [6]. This method has a general therapeutic effect and causes more chances of injury, so it is not \nwidely used clinically. \n3.1.2.4. Nerve block therapy \nDuring the development of chronic pelvic pain, repeated stimulation can induce pathological \nchanges in the cells of the dorsal horn of the spinal cord, generating reverse action potentials, and nerve \nendings release substances and nerve growth factors that enhance the transmission of peripheral \nnociceptive signals to the center. It also induces ecto pic electrical activity, which causes abnormal \nnerves to produce electrical activity in the absence of external stimulation, resulting in nociceptive \nhyperalgesia and sensory abnormalities. Therefore, nerve block therapy can be used as a third method \nfor the treatment of chronic pelvic pain and dysmenorrhea. Nerve block therapy refers to the use of \ndrugs or physical measures to block the conduction function of local sensory nerve fibers for the \npurpose of relieving or eliminating pain. The use of drugs, i.e . chemical nerve block therapy, involves \nthe injection of local anesthetics or drugs that destroy nerve tissue into the nerve local to block or \ndestroy the conduction function of nerve fibers to achieve temporary or long -lasting bouts of pain. \nWhen pharmacological and surgical treatments are ineffective or not preferred, nerve block therapy is a \npromising treatment \n[18]. \n3.1.3. Physiotherapy \nDue to the fact that the causes of pain may be multifaceted, such as physical and psychological \nfactors, therefore ou r treatment method should also adopt a multidisciplinary collaborative approach. \nThe combination of various physical therapies has achieved good therapeutic effects on chronic pelvic \npain. (Figure 3) \n \nFigure 3: physiotherapy \n3.1.3.1. Pelvic floor rehabilitation therapy \nPelvic floor rehabilitation therapy stimulates the patient's nerves and allows the muscles in the \npelvic area to contract freely and be used scientifically, which in turn promotes normal blood flow [19]. \n3.1.3.2. Electrical stimulation  \nLocal electrical stimulation can close the pain penetration gate and accelerate muscle contraction by \n\n\nInternational Journal of Frontiers in Medicine \nISSN 2706-6819 V ol.5, Issue 5: 84-91, DOI: 10.25236/IJFM.2023.050515 \nPublished by Francis Academic Press, UK \n-89- \nexciting the crude fibers, thus promoting blood circulation, reducing pelvic stasis, and promoting the \nreduction of pelvic inflammatory response for t he purpose of improving chronic pelvic pain treatment. \nMeanwhile, electrical stimulation can activate endogenous morphine-peptide-ergic neurons in the brain \nand reduce pain by inhibiting prostaglandin secretion [20]. In addition, the electric current of el ectrical \nstimulation treatment can pass through the pelvic tissues and reduce pelvic pain symptoms. \n3.1.3.3. Pelvic floor biofeedback  \nPelvic floor biofeedback is an electronic biofeedback therapy instrument that converts information \nabout pelvic floor mus cle activity into auditory and visual signals through the vagina or rectum and \nfeeds back to patients, allowing them to perform autonomous pelvic floor muscle training under the \nguidance of a physician, promoting the formation of conditioned reflexes, whic h in turn enhances the \neffect of pelvic floor muscle training and promotes pelvic floor muscle recovery [21]. \n3.1.3.4. Pelvic floor dysfunction treatment instrument \nNot only far-infrared heat therapy function, but also magnetic field therapy function, infr ared light \nand heat radiation can effectively promote local vasodilation, accelerate blood flow rate, improve local \ntissue nutritional status, and promote body microcirculation, thus enhancing body macrophage function \nand leukocyte function. At the same ti me, the heat therapy function of the pelvic inflammatory therapy \ninstrument can effectively improve the efficacy of drugs, prolong the action time of drugs and promote \npelvic blood circulation. And the magnetic field therapy of pelvic inflammatory disease treatment \ninstrument can also make the drugs work better on the lesion and make the drug effect play to the \nmaximum intensity \n[22]. \n3.1.3.5. Magnetic therapy \nMagnetic therapy is a new treatment method, which is designed according to Faraday's law of \nelectromagnetic induction, using a certain intensity of time -varying magnetic field to stimulate \nexcitable tissues, thus generating induced currents in the tissues. Magnetic stimulation technique is \neasy to operate, safe, painless, noninvasive, noninvasive, and penetrating. The magnetic treatment \nrange is deeper and wider, which can stimulate pelvic floor muscle contraction, promote pelvic floor \nblood circulation, increase the number of muscle fiber recruitment, relax the pelvic floor muscles, and \ncorrect muscle overactivity and dysfunction \n[23]. \n3.2. Traditional Chinese medicine \nChinese medicine does not have the name of chronic pelvic pain, and according to its symptoms, it \nis classified as \"subterranean disease\" and \"abdominal pain in women\". Some medical pract itioners [24] \nbelieve that the main pathogenesis of this disease is the stagnation of dampness, which tends to block \nthe qi mechanism, resulting in abnormal elevation of qi, stagnation of qi and blood stasis, and finally \ndampness and heat stasis, which leads to spleen deficiency and loss of transportation, and no source of \nqi and blood biochemical, resulting in the retention of the disease, lingering and recurrent attacks. \n(Table 2) \nTable 2: Chinese Medicine Treatments \nChinese Medicine Retention Enema \nIt can unblock local blood circulation and accelerate the \nimprovement of symptoms \nTopical Chinese Medicine Directly absorbed by the skin \nAcupuncture Treatments Improves local blood supply and circulation in the lower \nabdomen, pelvis and lumbosacral region \nChinese herbal collapse treatment Relieving blood stasis and pain, unblocking the \nmeridians \nPelvic Exercises Regulates qi and blood and unblocks the meridians \nMyofascial manipulation Relieves muscle spasm, promotes blood circulation and \nimproves tissue metabolism \n3.2.1. Retention enema of Chinese medicine \nChinese medicine enema can be applied directly to the local area, which can directly reach the \nlesion and be absorbed through the rectum - inferior vena cava, reducing the first -pass effect of the \nliver and increasing the concentration of local blood medic ine in the intestine. Local blood circulation \ncan be unblocked, accelerating the improvement of symptoms and promoting inflammation. Or \nmicrowave irradiation can be used as an adjunct to treatment, using the biological tissue itself as the \n\nInternational Journal of Frontiers in Medicine \nISSN 2706-6819 V ol.5, Issue 5: 84-91, DOI: 10.25236/IJFM.2023.050515 \nPublished by Francis Academic Press, UK \n-90- \ninternal heating  of the heat source, with a certain degree of deep penetration after internal heating, \ndirectly improving local blood circulation [25]. \n3.2.2. External application of Chinese medicine \nThe external application of Chinese herbal medicine makes the drug direc tly absorbed by skin \npenetration, and it is easy to operate and has high patient compliance, which is useful for relieving the \nsymptoms and psychological stress of patients with chronic pelvic pain [26]. \n3.2.3. Acupuncture treatment \nAcupuncture treatment i s mainly based on the identification of internal organs and meridians, and \nguided by the meridian theory, through acupuncture acupoints to balance yin and yang, regulate the \ninternal organs, and unblock the meridians, which can improve the local blood supply and circulation \nin the small abdomen, pelvis, and lumbosacral area, and relieve or eliminate pain. And acupuncture or \nacupuncture combined with other therapies for chronic pelvic pain is effective, safe, and operable, and \nhas certain advantages over surgery and drug therapy [27]. \n3.2.4. Chinese herbal collapse treatment \nIn the treatment of patients with chronic pelvic pain, Chinese herbal medicine can directly penetrate \ninto the hairy orifices through the epidermis to resolve blood stasis and relieve pai n and unblock the \nmeridians, which has a better clinical effect. \n3.2.5. Pelvic exercise \nBased on the physiological structure and anatomical characteristics of the female pelvis, pelvic \nexercises, to a certain extent, grad ually established a set of abdomina l exercises based on the organic \ncombination of Chinese medicine meridian theory and qi-blood theory, can achieve the effect of fitness \nwhile treating, and in the process of regulating qi -blood and unblocking the meridians, it helps to truly \nrelieve pelvic adhesions and absorb pelvic inflammation, and helps to promote the realization of \"no \npain if you pass\" and has the effect of analgesic treatment. At the same time, pelvic exercise is an \naerobic exercise with abdominal breathing, which will strengthen the  pelvic ligaments in particular by \ncoordinating the movement of the whole body. Blood vessels and muscles, which in turn helps blood \ncirculation, avoiding the production of lower limb veins and pelvic stasis, and helps absorb local stasis \nand inflammation, promoting a significant increase in local oxygen uptake, and a series of discomfort \nsymptoms can be effectively improved, such as lumbosacral pain and lower abdominal cramping \n[28]. \n3.2.6. Myofascial manipulation massage \nThe use of muscle pulling method and deep pressure method can reduce neuromuscular excitation, \nrelieve muscle spasm, promote blood circulation and improve tissue metabolism [23].  \n4. Summary \nChronic pelvic pain has complex etiology, involves more disciplines, and has various clinical \nmanifestations. The clinic should pay attention to the questioning of medical history and \ncomprehensive physical examination, pay attention to the differential diagnosis of gynecological \nfactors and chronic pelvic pain caused by other systemic factors, treat the etiology to obtain better \ntreatment efficiency, and adopt targeted and individualized treatment plan for patients with clear \netiology. At present, the clinical unified treatment method about chronic pelvic inflammatory disease is \nusually given a combination of medication, surgical intervention, physical therapy and Chinese \nmedicine characteristic treatment. Since the etiology of CPP can exist alone or in combination, \nmultidisciplinary cooperation should be emphasized in the process of diagnosis and treatment. \nReferences \n[1] Liu Wenjing, Liu Jie, Li Jian . Clinical Experience on Treatment of Gynecological Chronic Pelvic \nPain from the Liver [J]. Chinese Medicine Modern Distance Education of China, 2021, 19(8):150-151.   \n[2] Wang Yu, Zheng Ping. Research progress of chronic pelvic pain induced by gynecological fators  \n[J]. China Medical Herald, 2016, 13(5):36-40. \n[3] LI Guo xin, Study on Chronic Pelvic Pain Caused by Gynecological Factors  [J]. Medical \nInformation, 2020, 33(5):59-61. \n[4] Jiang Jianfa, Sun Aijun.  Introduction to the Diagnosis and Treatment of Chronic Pelvic Pain in \n\nInternational Journal of Frontiers in Medicine \nISSN 2706-6819 V ol.5, Issue 5: 84-91, DOI: 10.25236/IJFM.2023.050515 \nPublished by Francis Academic Press, UK \n-91- \nWomen [J]. Chinese Journal of Pain Medicine, 2014, 0(10):689-693. (in Chinese) \n[5] Xie Chan, Ge Yingli, Cai Yue, et. Treatment Progress of Traditional Chinese and Western Medicine \nfor Chronic Pelvic Pain in Gynecology [J]. Journal of New Chinese Medicine, 2022, 4(5):29-33. \n[6] Gao Hongxia.  Research on the pathogenesis and diagnosis and treatment of non -inflammatory \nchronic pelvic pain [J].Contemporary Medical Symposium, 2020, 18(18):22-24. \n[7] Fu Xiaowen, Yao Liyan, Wang Hu . Correlation analysis of lesion features in patients with \nendometriosis and pelvic pain [J]. Xinjiang Medical Journal, 2018, 48(3):291-294. \n[8] Tao Muheng, Xiao Peina, Ye Mingzhu.  Research Progress in Pathogenesis and Treatment of \nChronic Pelvic Pain [J], Medical Recapitulate, 2022, 28(4):736-741. \n[9] Tettambel MA. An osteopathic approach to treating women with chronic pelvic pain. J Am \nOsteopath Assoc. 2005 Sep; 105 (9 Suppl 4): S20-2. PMID: 16249362. \n[10] Berkley KJ. A life of pelvic pain. Physiol Behav. 2005 Oct 15, 86(3):272-80. \n[11] Wang Wen, Cui Xiujuan, Tian Xiangyu. Diagnosis and treatment of endometriosis complicated \nwith adenomyosis [J]. International Medicine and Health Guidance News, 2022, 28(5):687-691. \n[12] Liu Zhaohui, Liao Qinping, Xue Fengxia, et. Study on Kangfuxiaoyan Shuan's therapeutic efficacy \nof pelvic pain which is caused by pelvic inflammatory disease  [J]. Chinese Journal of Practical \nGynecology and Obstetrics, 2013, 29(8):666-668.  \n[13] Ho u Zheng, Niu Ziru, Yao Ying, et al.  Clinical Analysis of Causes and Treatment of Chronic \nPelvic Pain in Post-surgical Female Patients [J]. Chinese Journal of Minimally Invasive Surgery, 2021, \n21(1):31-35. \n[14] Zhan g Weiyin g, Li Huan, Qi Feng, et al.  Clinical observation of percutaneous low frequency \npulse electrical stimulation on 35 cases with chronic pelvic pain[J]. Proceeding of Clinical Medicine, \n2012, 21(6):422-424. \n[15] Wang Xiaowei, Gao Xiaoyan. Clinical Study of Traditional Chinese Medicine Enema Combined \nwith Low-frequency Pulsed Electrical Acupoint Stimulation in the Treatment of SPID Chronic Pelvic \nPain (Damp-heat Stasis Type)[J].Systems Medicine, 2022, 7(18):146-150. \n[16] Huo Yuxia. Clinical Observation of Chr onic Pelvic Pain Caused by Endometriosis Treated by \nTraditional Chinese Medicine Based on Constitution Theory of Traditional Chinese Medicine[D]. \nHeilongjiang University of Traditional Chinese Medicine, 2021. \n[17] Zhang Yanxue, Wang Changhong, Tian Ling , et al.  Clinical Research of Pelvic Inflammatory \nDisease Treated with Sanjie Zhentong Capsules and Steaming - Thermal Therapy[J]. World Journal of \nIntegrated Traditional and Western Medicine, 2013,8(12):1229-1231. \n[18] Shi Biao. Study of nerve block therapy f or chronic pelvic pain and dysmenorrhea[J]. Electronic \nJournal of Clinical Medicine Literature, 2020, 7(05):75+86.(in Chinese) \n[19] Fu Lixia, Tao Yuling, Li Chenni.  Clinical efficacy of pelvic floor rehabilitation therapy combined \nwith moxibustion at the e ight acupoints in the treatment of chronic pelvic pain [J]. The Journal of \nMedical Theory and Practice, 2021, 34(18):3294-3296.(in Chinese) \n[20] Cui Yangyang, Sun Weiwei, Zhao Ruihua. Systematic Review of Chinese Herbal Medicine for \nControlling Recurrence of Endometriosis after Operation  [J]. Journal of Shandong University of \nTraditional Chinese Medicine, 2014, 0(6):529-533. \n[21] Lu Lanying, Ma Hailan, Lan Xueqin. A study on application of pelvic floor muscle function \ntraining and electrical stimulation com bined with biofeedback therapy after panhysterectomy[J]. \nChinese Youjiang Medical Journal, 2017, 45(1):42-46. \n[22] Zhong Qihuan. Rehabilitation treatment experience of chronic pelvic pain [J]. Women's Health \nResearch, 2018(03):65-66.(in Chinese) \n[23] Wu Haifang, Wang Wei. Effect of myofascial massage combined with magnetic therapy on chronic \npelvic pain [J]. Electronic Journal of Practical Gynecologic Endocrinology, 2022, 9(4):34-36. \n[24] Yang Ruihong, Wang Shuhe, Zhu Ying. Experience of Professor Zhu Ying in Treating Chronic \nPelvic Pain Caused by Pelvic Inflammatory Disease Sequela [J]. Guangming Journal o f Chinese \nMedicine, 2022, 37(21):3967-3969. \n[25] Wang Weixiu, Hu Dieyan. Clinical Observation on Chinese Medicine Retention Enema and Whole \nBody Fumigation and Washing in the Treatment of Chronic Pelvic Inflammatory Disease  [J]. Chinese \nMedicine Modern Distance Education of China, 2023, 21(1):48-50. \n[26] Y u Yanyan, Huang Wenling, Zhao Jiajing, et al.  Study on the optimization scheme of TCM \nexternal application with modified Wenjing Decoction on chronic pelvic pain  [J]. Modern Journal of \nIntegrated Traditional Chinese and Western Medicine, 2021, 30(23):2528-25322567. \n[27] Shi Qiao, Xiao Xinchun . Mechanism of Acupuncture in Treating Chronic Pelvic Pain Based on \nMeridians and Acupoints [J]. Western Journal of Traditional Chinese Medicine, 2021, 34(7):117-119. \n[28] Deng Qing. The application of the holistic nursing combined with pelvic exercise in patients  with \nchronic pelvic inflammatory disease[J]. The Medical Forum, 2021, 25(36):5197-5199.","source_license":"CC0","license_restricted":false}