A deep insight into pelvic pain and endometriosis: a review of the literature from pathophysiology to clinical expressions

Luisa Masciullo, Maria Federica Viscardi, Maria F Viscardi, Ilaria Piacenti, Sara Scaramuzzino, Alessandra Cavalli, Maria Grazia Piccioni, Maria G Piccioni, Maria G Porpora, Maria Grazia Porpora
Minerva obstetrics and gynecology · 2021 · vol. 73(5) , pp. 511–522 · doi:10.23736/s2724-606x.21.04779-1 · PMID:33904687 · W3157590230
review OA: closed CC0 ⤵ 15 in-corpus citations
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⚙ AI-generated summary by claude@2026-06, 2026-06-06 ⓘ

This review examines recent literature on endometriosis-related pelvic pain, detailing its complex pathophysiology involving peripheral and central mechanisms, immune dysfunction, and the HPA axis, rather than its stage.

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Abstract

INTRODUCTION: Endometriosis is a chronic inflammatory disease that affects approximately 10% of women of reproductive age. Its clinical manifestations are highly heterogeneous, but pelvic pain is the most frequent, causing functional disability. Cyclic or acyclic chronic pelvic pain (CPP), dysmenorrhea and dyspareunia are frequent symptoms which often compromise all aspects of the women's quality of life (QoL). The pathophysiology of endometriosis-related pain is extremely complex and not always clear. The aim of this systematic review was to focus on recent updates on the clinical presentation, the pathophysiology and the most important mechanisms involved in the pathogenesis of pelvic pain in endometriosis. EVIDENCE ACQUISITION: A literature search in the Cochrane library, PubMed, Scopus and web of Science databases has been performed, identifying articles from January 1995 to November 2020. EVIDENCE SYNTHESIS: Several processes seem to be involved in the pathogenesis of pain, but many aspects are still unclear. Scientific evidence has shown that a correlation between pain severity and stage of endometriosis rarely occurs, whereas there is a significant correlation between pain and the presence of deep endometriosis. Onset and intensity of pain may be due to a complex process involving central sensitization and peripheral activation of nociceptive pathways as well as dysfunction of the immune system and of the hypothalamic-pituitary-adrenal (HPA) axis. CONCLUSIONS: A deeper understanding of these different pathogenetic mechanisms may improve future treatments in women with painful endometriosis.

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Condition tags

dysmenorrheadyspareuniaendometriosischronic_pelvic_pain

MeSH descriptors

Dyspareunia Dyspareunia Endometriosis Endometriosis Dysmenorrhea Dysmenorrhea Female Humans Pelvic Pain Pelvic Pain Quality of Life

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

References (100)

Cited by (16)

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