CENTRAL SENSITIZATION SYNDROME IN PATIENTS WITH PELVIC ORGAN PROLAPSE - MECHANISMS, DIAGNOSTICS, AND THERAPEUTIC APPROACHES

Background: Central Sensitization Syndrome (CSS) is increasingly recognized as a critical contributor to chronic pelvic pain in women with pelvic organ prolapse (POP). The coexistence of mechanical dysfunction and altered central pain modulation complicates diagnosis and management, requiring a multidimensional approach that integrates neurobiological, hormonal, and psychosocial perspectives. Objective: To analyze the mechanisms of central sensitization in women with pelvic organ prolapse, review current diagnostic methods, and evaluate therapeutic strategies based on recent scientific evidence. Methods: A narrative evidence-based review was conducted using PubMed, Scopus, and Web of Science databases for publications from 2015 to 2024. Studies addressing the mechanisms, diagnosis, and treatment of central sensitization in pelvic organ prolapse or related chronic pelvic pain syndromes were included. Data were synthesized qualitatively with critical appraisal of methodological rigor and clinical relevance. Results: The literature confirms that chronic pain in women with POP often results from maladaptive neuroplasticity and central hypersensitivity rather than from anatomical defects alone. Estrogen deficiency, neuroinflammation, and prolonged nociceptive stimulation act synergistically to maintain central excitability. Effective diagnostics require a combination of clinical evaluation, validated questionnaires, quantitative sensory testing, and neuroimaging. Treatment should follow a biopsychosocial model that integrates pharmacotherapy (gabapentinoids, SNRIs, anti-inflammatory agents), physiotherapy, and psychological interventions such as cognitive-behavioral therapy. Noninvasive neuromodulation and molecular therapies targeting NMDA and TRPV1 receptors show emerging promise. Conclusions: Central sensitization represents a pivotal but underdiagnosed mechanism in the pathophysiology of pelvic organ prolapse–related pain. Early identification of CSS features and implementation of individualized multimodal therapy improve pain control, functional outcomes, and quality of life. Multidisciplinary collaboration remains essential for optimizing diagnosis and treatment in this complex patient population.