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

Paolo Vercellini, Edgardo Somigliana, Paola Viganò, Annalisa Abbiati, Giussy Barbara, Luigi Fedele

Research output: Contribution to journalArticle

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.

Original languageEnglish
Pages (from-to)149-158
Number of pages10
JournalGynecological Endocrinology
Volume25
Issue number3
DOIs
Publication statusPublished - Mar 2009

Keywords

  • Chronic pelvic pain
  • Interstitial cystitis
  • Irritable bowel syndrome
  • Pelvic varices
  • Post-operative adhesions

ASJC Scopus subject areas

  • Endocrinology
  • Endocrinology, Diabetes and Metabolism
  • Obstetrics and Gynaecology

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