Chronic pelvic pain in women - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Chronic pelvic pain is a syndrome of pain arising from one or more pelvic organs, and can include any one or all pelvic viscera or muscles.
A methodical, complete, criteria-based history is required to determine how many and which organ systems are involved and to uncover comorbid psychiatric conditions, particularly depression or a history of abuse.
The physical exam must be methodical and complete, searching for point tenderness in all individual pelvic muscles and organs, specifically including the vestibule, levator ani muscles, bladder, cervix and uterus, adnexa, and lower abdominal wall.
Diagnostic tests are determined by the organ systems generating pain and may include urinalysis with culture, pelvic ultrasound, cystoscopy with hydrodistension, and diagnostic laparoscopy.
Because chronic pain is sometimes a disorder of pain perception, minimal if any pathologic change may be found.

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History & Exam
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Diagnostics Tests
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Definition

Epidemiology

Etiology

Pathophysiology

Citations

Key Articles

American College of Obstetricians and Gynecologists. Practice bulletin no. 114: management of endometriosis. Jul 2010 [internet publication].[Full Text]
Engeler D, Baranowski AP, Berghmans B, et al; European Association of Urology. Guidelines on chronic pelvic pain. 2023 [internet publication].[Full Text]
Clemens JQ, Erickson DR, Varela NP, et al. Diagnosis and treatment of interstitial cystitis/bladder pain syndrome. J Urol. 2022 Jul;208(1):34-42.[Abstract][Full Text]
Yunker A, Sathe NA, Reynolds WS, et al. Systematic review of therapies for noncyclic chronic pelvic pain in women. Obstet Gynecol Surv. 2012 Jul;67(7):417-25.[Abstract]

Other Online Resources

International Pelvic Pain Society: history and physical form

Referenced Articles

1. Chronic Pelvic Pain: ACOG Practice Bulletin, Number 218. Obstet Gynecol. 2020 Mar;135(3):e98-e109.[Abstract]
2. Wolfe F, Smythe HA, Yunus MB, et al. The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Arthritis Rheum. 1990 Feb;33(2):160-72.[Abstract]
3. Turini D, Beneforti P, Spinelli M, et al. Heat/burning sensation induced by topical application of capsaicin on perineal cutaneous area: new approach in diagnosis and treatment of chronic prostatitis/chronic pelvic pain syndrome? Urology. 2006 May;67(5):910-3.[Abstract]
4. Mathias SD, Kuppermann M, Liberman RF, et al. Chronic pelvic pain: prevalence, health-related quality of life, and economic correlates. Obstet Gynecol. 1996 Mar;87(3):321-7.[Abstract]
5. American College of Obstetricians and Gynecologists. Committee opinion no. 554: reproductive and sexual coercion. Feb 2013 [internet publication].[Full Text]
6. American College of Obstetricians and Gynecologists. Committee opinion no. 518: intimate partner violence. 2022 [internet publication].[Full Text]
7. Fenton BW. Limbic associated pelvic pain: a hypothesis to explain the diagnostic relationships and features of patients with chronic pelvic pain. Med Hypotheses. 2007;69(2):282-6.[Abstract]
8. Porpora MG, Koninckx PR, Piazze J, et al. Correlation between endometriosis and pelvic pain. J Am Assoc Gynecol Laparosc. 1999 Nov;6(4):429-34.[Abstract]
9. Won HR, Abbott J. Optimal management of chronic cyclical pelvic pain: an evidence-based and pragmatic approach. Int J Womens Health. 2010 Aug 20;2:263-77.[Abstract][Full Text]
10. Kissler S, Hamscho N, Zangos S, et al. Uterotubal transport disorder in adenomyosis and endometriosis--a cause for infertility. BJOG. 2006 Aug;113(8):902-8.[Abstract][Full Text]
11. Warren JW, Morozov V, Howard FM. Could chronic pelvic pain be a functional somatic syndrome? Am J Obstet Gynecol. 2011 Sep;205(3):199.e1-5.[Abstract]
12. Butrick CW. Interstitial cystitis and chronic pelvic pain: new insights in neuropathology, diagnosis, and treatment. Clin Obstet Gynecol. 2003 Dec;46(4):811-23.[Abstract]
13. Kirsch R, Riddell RH. Histopathological alterations in irritable bowel syndrome. Mod Pathol. 2006 Dec;19(12):1638-45.[Abstract]
14. Pukall CF, Strigo IA, Binik YM, et al. Neural correlates of painful genital touch in women with vulvar vestibulitis syndrome. Pain. 2005 May;115(1-2):118-27.[Abstract]
15. Champaneria R, Shah L, Moss J, et al. The relationship between pelvic vein incompetence and chronic pelvic pain in women: systematic reviews of diagnosis and treatment effectiveness. Health Technol Assess. 2016 Jan;20(5):1-108.[Abstract][Full Text]
16. Poleshuck EL, Dworkin RH, Howard FM, et al. Contributions of physical and sexual abuse to women's experiences with chronic pelvic pain. J Reprod Med. 2005 Feb;50(2):91-100.[Abstract]
17. American College of Obstetricians and Gynecologists. Committee opinion no. 498: adult manifestations of childhood sexual abuse. Obstet Gynecol. 2011 Aug;118(2 Pt 1):392-5.[Abstract]
18. American College of Obstetricians and Gynecologists. Committee opinion no. 547: health care for women in the military and women veterans. Dec 2012 [internet publication].[Full Text]
19. Latthe P, Mignini L, Gray R, et al. Factors predisposing women to chronic pelvic pain: systematic review. BMJ. 2006 Apr 1;332(7544):749-55.[Abstract][Full Text]
20. American College of Obstetricians and Gynecologists. Practice bulletin no. 114: management of endometriosis. Jul 2010 [internet publication].[Full Text]
21. Howard FM. Chronic pelvic pain. Obstet Gynecol. 2003 Mar;101(3):594-611.[Abstract]
22. Engeler D, Baranowski AP, Berghmans B, et al; European Association of Urology. Guidelines on chronic pelvic pain. 2023 [internet publication].[Full Text]
23. Fletcher SG, Zimmern PE. Differential diagnosis of chronic pelvic pain in women: the urologist's approach. Nat Rev Urol. 2009 Oct;6(10):557-62.[Abstract]
24. Rawicki B, Sheean G, Fung VS, et al; Cerebral Palsy Institute. Botulinum toxin assessment, intervention and aftercare for paediatric and adult niche indications including pain: international consensus statement. Eur J Neurol. 2010 Aug;17(suppl 2):122-34.[Abstract]
25. Butrick CW. Pelvic floor hypertonic disorders: identification and management. Obstet Gynecol Clin North Am. 2009 Sep;36(3):707-22.[Abstract]
26. American College of Radiology; Society for Pediatric Radiology; Society of Skeletal Radiology. Practice parameter for the performance and interpretation of magnetic resonance imaging (MRI) of the hip and pelvis for musculoskeletal disorders. 2021 [internet publication].[Full Text]
27. Clemens JQ, Erickson DR, Varela NP, et al. Diagnosis and treatment of interstitial cystitis/bladder pain syndrome. J Urol. 2022 Jul;208(1):34-42.[Abstract][Full Text]
28. European Society of Human Reproduction and Embryology. ESHRE guideline on the management of women with endometriosis. Feb 2022 [internet publication].[Full Text]
29. Bayoglu Tekin Y, Dilbaz B, Altinbas SK, et al. Postoperative medical treatment of chronic pelvic pain related to severe endometriosis: levonorgestrel-releasing intrauterine system versus gonadotropin-releasing hormone analogue. Fertil Steril. 2011 Feb;95(2):492-6.[Abstract]
30. Coccia ME, Rizzello F, Palagiano A, et al. Long-term follow-up after laparoscopic treatment for endometriosis: multivariate analysis of predictive factors for recurrence of endometriotic lesions and pain. Eur J Obstet Gynecol Reprod Biol. 2011;157:78-83.[Abstract]
31. Hsu AL, Sinaii N, Segars J, et al. Relating pelvic pain location to surgical findings of endometriosis. Obstet Gynecol. 2011 Aug;118(2 Pt 1):223-30.[Abstract][Full Text]
32. Stratton P, Berkley KJ. Chronic pelvic pain and endometriosis: translational evidence of the relationship and implications. Hum Reprod Update. 2011 May-Jun;17(3):327-46.[Abstract][Full Text]
33. Yunker A, Sathe NA, Reynolds WS, et al. Systematic review of therapies for noncyclic chronic pelvic pain in women. Obstet Gynecol Surv. 2012 Jul;67(7):417-25.[Abstract]
34. Lamvu G. Role of hysterectomy in the treatment of chronic pelvic pain. Obstet Gynecol. 2011 May;117(5):1175-8.[Abstract]
35. Sesti F, Capozzolo T, Pietropolli A, et al. Dietary therapy: a new strategy for management of chronic pelvic pain. Nutr Res Rev. 2011 Jun;24(1):31-8.[Abstract]
36. Nickel JC, Barkin J, Forrest J, et al. Randomized, double-blind, dose-ranging study of pentosan polysulfate sodium for interstitial cystitis. Urology. 2005 Apr;65(4):654-8.[Abstract]
37. Turner KJ, Stewart LH. How do you stretch a bladder? A survey of UK practice, a literature review, and a recommendation of a standard approach. Neurourol Urodyn. 2005;24(1):74-6.[Abstract]
38. Fariello JY, Whitmore K. Sacral neuromodulation stimulation for IC/PBS, chronic pelvic pain, and sexual dysfunction. Int Urogynecol J. 2010 Dec;21(12):1553-8.[Abstract]
39. Marcelissen T, Jacobs R, van Kerrebroeck P, et al. Sacral neuromodulation as a treatment for chronic pelvic pain. J Urol. 2011 Aug;186(2):387-93.[Abstract]
40. Horne AW, Vincent K, Cregg R, et al. Is gabapentin effective for women with unexplained chronic pelvic pain? BMJ. 2017 Sep 21;358:j3520.[Abstract]
41. Montenegro ML, Vasconcelos EC, Candido Dos Reis FJ, et al. Physical therapy in the management of women with chronic pelvic pain. Int J Clin Pract. 2008 Feb;62(2):263-9.[Abstract]
42. Andrews JC. Vulvodynia interventions: systematic review and evidence grading. Obstet Gynecol Surv. 2011 May;66(5):299-315.[Abstract]
43. Foster DC, Kotok MB, Huang LS, et al. Oral desipramine and topical lidocaine for vulvodynia: a randomized controlled trial. Obstet Gynecol. 2010 Sep;116(3):583-93.[Abstract]
44. Haefner HK, Collins ME, Davis GD, et al. The vulvodynia guideline. J Low Genit Tract Dis. 2005 Jan;9(1):40-51.[Abstract][Full Text]
45. Priya K, Rajaram S, Goel N. Comparison of combined hormonal vaginal ring and low dose combined oral hormonal pill for the treatment of idiopathic chronic pelvic pain: a randomised trial. Eur J Obstet Gynecol Reprod Biol. 2016 Dec;207:141-6.[Abstract]
46. Nickel JC, Barkin J, Forrest J, et al. Randomized, double-blind, dose-ranging study of pentosan polysulfate sodium for interstitial cystitis. Urology. 2005 Apr;65(4):654-8.[Abstract]
47. Boardman LA, Cooper AS, Blais LR, Raker CA. Topical gabapentin in the treatment of localized and generalized vulvodynia. Obstet Gynecol. 2008 Sep;112(3):579-85.[Abstract]
48. Champaneria R, Daniels JP, Raza A, et al. Psychological therapies for chronic pelvic pain: systematic review of randomized controlled trials. Acta Obstet Gynecol Scand. 2012 Mar;91(3):281-6.[Abstract]
49. Morone NE, Greco CM, Weiner DK. Mindfulness meditation for the treatment of chronic low back pain in older adults: A randomized controlled pilot study. Pain. 2008 Feb;134(3):310-9.[Abstract]
50. Fox SD, Flynn E, Allen RH. Mindfulness meditation for women with chronic pelvic pain: a pilot study. J Reprod Med. 2011 Mar-Apr;56(3-4):158-62.[Abstract]
51. Cote JN, Hoeger Bement MK. Update on the relation between pain and movement: consequences for clinical practice. Clin J Pain. 2010 Nov-Dec;26(9):754-62.[Abstract]
52. Berna C, Vincent K, Moore J, et al. Presence of mental imagery associated with chronic pelvic pain: a pilot study. Pain Med. 2011 Jul;12(7):1086-93.[Abstract][Full Text]
53. McCleane GJ, Suzuki R, Dickenson AH. Does a single intravenous injection of the 5HT3 receptor antagonist ondansetron have an analgesic effect in neuropathic pain? A double-blinded, placebo-controlled cross-over study. Anesth Analg. 2003 Nov;97(5):1474-8.[Abstract]
54. Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. MMWR Recomm Rep. 2021 Jul 23;70(4):1-187.[Abstract][Full Text]