Pathophysiology of Chronic Pelvic Pain

This chapter reviews the pathophysiology of chronic pelvic pain (CPP) in women, which includes neurobiological, immunological, endocrine and psychological factors, which interact at several levels. CPP constitutes a multifactorial clinical entity with a reported prevalence between 12 and 39. Both pre and postmenopausal women may suffer from CPP, though younger women seem to be more susceptible in a recent study conducted in the United Kingdom (UK), with a reported aggregated prevalence of 14.8%. Urinary and gastrointestinal tracts are more commonly implicated in CPP than gynaecological causes, with irritable bowel syndrome being the main contributor accounting for 12% of primary care appointments. A detailed understanding of the pelvic anatomy is essential to understand the pathophysiological aspects of CPP, especially regarding the complex neuroanatomy and neurobiology of this compartment. Central sensitization seems to be an integral part of the pathophysiological sequence in CPP.