Chronic Pelvic Pain: a Neuropsychiatric View of the Gynecological Problem

Ye.V. Sibirskaya, П.О. Никифорова
In: Effective Pharmacotherapy · 2023 · pp. 36–39 · doi:10.33978/2307-3586-2023-19-37-36-39 · W4389975693
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⚙ AI-generated summary by gemini-2.5-flash-lite, 2026-06-06 ⓘ

This paper examines chronic pelvic pain in women, highlighting its multifactorial nature, neuropsychiatric triggers like anxiety and stress, and significant impact on social and work life.

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The paper is a narrative review examining chronic pelvic pain (lasting ≥6 months and not cyclic) from a neuropsychiatric perspective, using literature searches of PubMed, Embase, Cochrane Library, and Google Scholar to synthesize systematic reviews, meta-analyses, and randomized trials published from 1988 to 2023. Across included studies, depression and anxiety are frequently reported as statistically associated with chronic pelvic pain, and several cited analyses describe bidirectional pathways in which pain can worsen mental health and stress or prior trauma can amplify pain; however, the review explicitly notes inconsistent findings (e.g., some studies show no significant associations, and not all pain is explained by psychogenic mechanisms). It also summarizes evidence on predictors (e.g., baseline pain severity, history of sexual violence), phenotypic features of pain in comorbid hypochondriacal disorder, and treatment comparisons such as combined pharmacotherapy and generally limited/conditional support for procedures like pelvic denervation, while noting persistent pain after hysterectomy for a substantial proportion. Relevance to endometriosis: the review cites endometriosis-specific examples (including reported amplification of pain with stress in adolescent patients with endometriosis) and includes studies of patients with endometriosis showing higher depression levels when chronic pelvic pain is present, though it is primarily a broad review of chronic pelvic pain’s neuropsychiatric contributors rather than endometriosis alone.

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Abstract

Chronic pelvic pain (CPP) in women is a multifactorial problem that requires an interdisciplinary approach involving the teamwork of an obstetrician-gynecologist and related specialists. In 80% of patients the causes of CPP are inorganic, while 40% of diagnostic laparoscopic operations and 12% of hysterectomies are performed annually. Pathogenetic reactions triggering CPP syndrome include increased anxiety, neurosis and concomitant high levels of stress. A cascade of such reactions leads to the formation of a vicious circle. CPP directly affects the social life of women. About 15% of women with CPP cannot work, and 45% have a noticeable decrease in productivity. Treatment of the psychoemotional component of CPP is a priority task of an obstetrician-gynecologist.
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Results

of a cross-sectional case-control study. World J. Psychiatry. 2016; 6 (3): 339–344. 25. Siqueira-Campos V .M.E., Da Luz R.A., de Deus J.M., et al. Anxiety and depression in women with and without chronic pelvic pain: prevalence and associated factors. J. Pain Res. 2019; 12: 1223–1233. 26. Romão A.P .M.S., Gorayeb R., Romão G.S., et al. High levels of anxiety and depression have a negative effect on quality of life of women with chronic pelvic pain. Int. J. Clin. Pract. 2009; 63 (5): 707–711. 27. Hodgkiss A.D., Sufraz R., Watson J.P . Psychiatric morbidity and illness behavior in women with chronic pelvic pain. J. Psychosom. Res. 1994; 38 (1): 3–9. 28. Lorençatto C., Petta C.A., Navarro M.J., et al. Depression in women with endometriosis with and without chronic pelvic pain. Acta Obstet. Gynecol. Scand. 2006; 85 (1): 88–92. 29. Slocumb J.C., Kellner R., Rosenfeld R.C., et al. Anxiety and depression in patients with the abdominal pelvic pain syndrome. Gen. Hosp. Psychiatry. 1989; 11 (1): 48–53. 30. Harrop-Griffiths J., Katon W ., Walker E., et al. The association between chronic pelvic pain, psychiatric diagnoses, and childhood sexual abuse. Obstet. Gynecol. 1988; 71 (4): 589–594. 31. Laborda E., Clarke A., Carpenter T. The threshold for laparoscopy for pelvic pain. Obstet. Gynaecol. 2010; 12 (1): 7–12. 32. Neis K.J., Neis F . Chronic pelvic pain: cause, diagnosis and therapy from a gynaecologist’s and an endoscopist’s point of view. Gynecol. Endocrinol. 2009; 25 (11): 757–761. Chronic Pelvic Pain: a Neuropsychiatric View of the Gynecological Problem Y e.V . Sibirskaya, PhD, Prof.1, 2, 3, 4, P .O. Nikiforova5 1 A.I. Yevdokimov Moscow State University of Medicine and Dentistry 2 Russian Children's Clinical Hospital of the N.I. Pirogov Russian National Research Medical University 3 N.I. Pirogov Russian National Research Medical University 4 Center for Reproductive Health of Adolescents in the Moscow Region on the basis of the Dolgoprudnenskaya Central City Hospital 5 N.I. Pirogov National Medical and Surgical Center Contact person: Y elena V . Sibirskaya, [email protected] Chronic pelvic pain (CPP) in women is a multifactorial problem that requires an interdisciplinary approach involving the teamwork of an obstetrician-gynecologist and related specialists. In 80% of patients the causes of CPP are inorganic, while 40% of diagnostic laparoscopic operations and 12% of hysterectomies are performed annually. Pathogenetic reactions triggering CPP syndrome include increased anxiety, neurosis and concomitant high levels of stress. A cascade of such reactions leads to the formation of a vicious circle. CPP directly affects the social life of women. About 15% of women with CPP cannot work, and 45% have a noticeable decrease in productivity. Treatment of the psychoemotional component of CPP is a priority task of an obstetrician-gynecologist.

Keywords

chronic pelvic pain, laparoscopy, psychosomatics, generalized anxiety disorder, endometriosis Обзор

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