Chronic pelvic pain syndrome in women: diagnostic and therapeutic aspects

This paper is a narrative review of chronic pelvic pain syndrome in women, defining chronic pelvic pain using European Association of Urology criteria and the IASP framework, and then summarizing epidemiology, proposed etiologies, pathophysiological mechanisms, clinical phenotypes, and management approaches based on literature searched in PubMed/Medline/Embase (2010–2020). It highlights that chronic pelvic pain can result from diverse biological and psychosocial factors, with mechanisms including neurogenic inflammation, chronic pelvic ischemia, pelvic floor muscle tension, autonomic dysfunction, and central sensitization, and that multiple pain conditions can co-occur; a key limitation explicitly noted is the lack of diagnostic standards and the difficulty of phenotyping, such as the inability (at present) to reliably separate painful bladder syndrome phenotypes without cystoscopy and biopsy. It also describes the organization of causes across urologic, gynecologic, gastrointestinal/pelvic, and musculoskeletal categories (including use of UPOINT domains) and discusses treatments such as cognitive behavioral therapy and pelvic floor-focused physical therapy approaches. Relevance to endometriosis: the review lists endometriosis-algomenorrhea among potential causes of chronic pelvic pain syndrome and places “painful syndrome in endometriosis” within its gynecologic pain categories, though the overall paper focus is broader chronic pelvic pain syndrome rather than endometriosis alone.

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