Aetiology of pelvic neuropathies in women: a scoping review

Background : Many women suffer from undiagnosed pelvic pain, potentially due to pelvic neuropathies, but are often treated symptomatically without addressing underlying causes. Pelvic neuropathies can cause severe symptoms, affecting quality of life and psychological well-being. Objectives: To provide an overview of all known aetiologies of pelvic neuropathies. Search Strategy: Database searches of PubMed, Embase.com, and Web of Science (Core Collection), as well as citations and reference lists published up to November 13, 2023. Selection criteria: For inclusion, the study needed to describe an aetiology of a located pelvic neuropathy that can occur in women. Excluded studies were those describing idiopathic neuropathy, reviews, and opinion articles. Main results: In total, 306 studies were included (268 case reports and series, 38 cohort studies), describing 2413 patients. Aetiologies of the included studies were divided into five categories and their subcategories, namely: iatrogenic (n=1094 patients, 45%), nerve invasion - mainly endometriosis (n=614 patients, 25%), pregnancy and birth (n=93 patients, 4%), trauma (n=202 patients, 8%), and compression (n=409 patients, 17%). Pelvic neuropathies were mainly described in the sciatic, femoral, obturator, lumbosacral roots, pudendal, lateral femoral cutaneous, and Ilioinguinal nerve. Conclusions: The vast majority of all described pelvic neuropathies were seen after surgery in the lower abdomen or pelvis. The second largest group of patients exhibited neuropathy caused by deep endometriosis of the sacral plexus and/or sciatic nerve. The five categories from this paper can assist clinicians in diagnosing and treating neuropathic pelvic pain. Funding : This study was not funded.