Chronic pelvic pain of unknown origin is potentially curable by uterosacral ligament repair

This editorial argues that chronic pelvic pain (CPP) labeled “of unknown origin” can be causally linked to uterine/apical prolapse–related laxity of uterosacral ligaments within a posterior fornix syndrome framework, where supportive repair (including native uterosacral ligament plication) restores function. It describes high-level diagnostic approaches such as a speculum test that mechanically supports the uterosacral ligaments and a Bornstein test using transvaginal local anesthetic to anesthetize visceral nerve plexuses, with reported outcomes from prior laparoscopic-controlled and pessary-related data. The author states a caveat regarding age-related collagen deficiency, proposing different repair strategies for older versus younger women. Relevance to endometriosis: the paper does not explicitly discuss endometriosis or adenomyosis; it was included in the corpus via a keyword match in the upstream search index.

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