Chronic pelvic pain syndrome. A multifactorial clinical picture with indication for interdisciplinary treatment

R Bodden-Heidrich
In: Der Gynäkologe · 2001 · vol. 34(4) , pp. 299–306 · doi:10.1007/s001290050715 · W2087799917
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Chronic pelvic pain syndrome (CPPS), affecting 15-30% of reproductive-aged women, is characterized by pain lasting over six months and requires interdisciplinary diagnosis of organic, non-gynecological, and psychosocial factors for indication and prognosis.

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This paper reviews chronic pelvic pain syndrome (CPPS), describing its epidemiology and the concept that pain persists for at least 6 months and has both an organic basis and psychological characteristics independent of organ findings. It outlines a multifactorial differential diagnosis encompassing gynecologic causes such as endometriosis, adhesions, and cysts, along with non-gynecologic conditions including gastrointestinal, lactose intolerance, urologic, surgical, and musculoskeletal disease, plus pelvic inflammatory disease and pelvic congestion syndrome. The authors emphasize that any indication for laparoscopy should be based on interdisciplinary diagnosis of organic gynecologic and non-gynecologic causes together with assessment of psychosocial state, including psychodiagnosis with trauma history and neurosis-oriented diagnoses. The paper provides a clinical framework rather than new empirical data, and it does not present a controlled study or quantify treatment outcomes. This paper centrally addresses chronic pelvic pain syndrome with explicit discussion of relevance to endometriosis—endometriosis is listed as a key gynecologic organ cause within the differential diagnosis for CPPS.

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Zusammenfassung Chronische Unterbauchschmerzen (chronic pelvic pain syndrome, CPPS) machen ca. 15–20% aller Konsultationen in der ambulanten gynäkologischen Versorgung aus, nahezu 40% aller Laparoskopien erfolgen wegen Unterbauchschmerzen. Bei Frauen im reproduktionsfähigen Alter besteht eine Prävalenz von 15–30%. Die Definition des CPPS bezieht sich auf die organische Basis und die psychologischen Charakteristika der Schmerzen, die unabhängig vom Organbefund 6 Monate bestehen. Gynäkologische und nichtgynäkologische Ursachen liegen als mögliche Organerkrankungen zugrunde: Endometriose, Adhäsionen, Zysten, “pelvic inflammatory disease” und “pelvic congestion syndrome”, gastrointestinale Erkrankungen, Laktoseintoleranz, urologische, chirurgische sowie muskuloskeletale Erkrankungen. Eine interdisziplinäre Diagnostik der organisch gynäkologischen, der organisch nichtgynäkologischen Ursachen und der psychosozialen Befindlichkeit muss zur Indikationsstellung einer Laparoskopie erfolgen. Die psychischen Faktoren beim CPPS müssen in jedem Fall beachtet und unabhängig vom Organbefund gewichtet werden. Eine interdisziplinäre Differentialdiagnostik sowie Psychodiagnostik inklusive Traumaanamnese sowie neurosenorientierte Diagnosen ergeben die Indikation und Prognose zur Behandlung. Die Befunde der Depressivität beim CPPS müssen um die Kenntnis und Abklärung eines zentralen Aggressionskonflikts mit Auswirkung auf die Behandlung erweitert werden. Abstract Chronic pelvic pain syndrome (CPPS) accounts for ca. 15–20% of all consultations in out-patient gynecological care; almost 40% of all laparascopies result from it. Its prevalence in women in reproductive age is 15–30%. The definition of CPPS refers to the organic basis and psychological characteristics of the pain, which, independently of organic findings, exists for 6 months. There are gynecological and nongynecological causes that form the basis for possible organ disease: endometriosis, adhesions, cysts, pelvic inflammatory disease, pelvic congestion syndrome, gastrointestinal disease, lactose intolerance, and urological, surgical, and musculoskeletal disease. An interdisciplinary diagnosis of the organic gynecological and nongynecological causes and of the patient's psychosocial state of being must be the basis for any indication of laparoscopy. The psychic factors in CPPS must always be taken into account and weighted independently of any organic findings. An interdisciplinary differential diagnosis, psychodiagnosis, including trauma anamnesis, and neurosis-oriented diagnoses provide the indicators and prognosis for treatment. The findings of depression in CPPS must be extended to include the recognition and clarification of any central aggressive conflict with effects on treatment. Similar content being viewed by others Author information Authors and Affiliations Rights and permissions About this article Cite this article Bodden-Heidrich, R. Chronische Unterbauchschmerzen “chronic pelvic pain syndrome”. Gynäkologe 34, 299–306 (2001). https://doi.org/10.1007/s001290050715 Issue date: DOI: https://doi.org/10.1007/s001290050715

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