Chronic pelvic pain in women: etiology, pathogenesis and diagnostic approach

Paolo Vercellini, Edgardo Somigliana, Paola Viganò, Annalisa Abbiati, Giussy Barbàra, Giussy Barbara, Luigi Fedele
Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology · 2009 · vol. 25(3) , pp. 149–158 · doi:10.1080/09513590802549858 · PMID:19347704 · W2117120599
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This paper reviews the etiology, pathogenesis, and diagnostic approach to chronic pelvic pain in women, highlighting various contributing systems and common causes like adhesions, varices, cystitis, and IBS.

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Abstract

Chronic pelvic pain (CPP), defined as non-cyclic pain of 6 or more months, is a frequent disorder that may negatively affect health-related quality of life. In women several causes are recognised, although in a not negligible proportion of patients a definite diagnosis cannot be made. Different neurophysiological mechanisms are involved in the pathophysiology of CPP. Pain may be classified as nociceptive or non-nociceptive. In the first case the symptom originates from stimulation of a pain-sensitive structure, whereas in the second pain is considered neuropatic or psychogenic. Patients history is crucial and is generally of utmost importance for a correct diagnosis, being sometimes more indicative than several diagnostic investigations. The main contributing factors in women with CPP can still be identified by history and physical examination in most cases. Many disorders of the reproductive tract, urological organs, gastrointestinal, musculoskeletal and psycho-neurological systems may be associated with CPP. Excluding endometriosis, the most frequent causes of CPP are: post-operative adhesions, pelvic varices, interstitial cystitis and irritable bowel syndrome. CPP is a symptom, not a disease, and rarely reflects a single pathologic process. Gaining women's trust and developing a strong patient-physician relationship is of utmost importance for the long-term outcome of care.

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Condition tags

mesh:D017699endometriosischronic_pelvic_paininterstitial_cystitisirritable_bowel_syndrome

MeSH descriptors

Pelvic Pain Pelvic Pain Chronic Disease Family Health Female Gynecology Gynecology Humans Pelvic Pain Reproductive History

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