Psychosomatische Aspekte chronischer Unterbauchschmerzen der Frau

Chronic pelvic pain is a clinically significant condition in gynecology due to the frequency with which it occurs but also because of the stress it causes for patients. This complex clinical presentation has different definitions in the literature but based on its symptoms, it is usually classified as belonging to the somatic pain disorders. It has a significant co-morbidity with other disorders, including menstrual disorders such as dysmenorrhea and certain rare bleeding disorders, excretory problems such as urinary urge incontinence and obstipation as well as a high number of sexual disorders and other genital disorders such as pruritus. This complexity requires an interdisciplinary approach, in which discussions addressing possible psychosomatic origins play a role in addition to medication or invasive procedures such as diagnostic and operative laparoscopy or hysterectomy procedures. For chronic manifestations of pelvic pain the multidisciplinary approach should also include treatment options such as balneotherapy, psychotherapy and systemic therapy. These options can include relaxation techniques and training on how to cope with pain. Psychosomatic primary care is particularly important, as often it is necessary to help the patient develop the motivation and willingness to attempt psychotherapy, i.e. to develop the required introspection and preparedness to acknowledge the possible psychological origin of the pain. In cases of chronic pain in-patient psychological care should also be available, as this setting offers the best combination of physical and psychotherapeutic treatment. A biopsychosocial clinical picture is necessary for the diagnosis and the therapy of chronic pelvic pain to ensure that the therapeutic concept will take account of somatic causes together with physical co-morbidities and social influences.