Causes of chronic pelvic pain

doi:10.1053/beog.1999.0082

Best Practice & Research Clinical Obstetrics & Gynaecology

Volume 14, Issue 3, June 2000, Pages 389-402

https://doi.org/10.1053/beog.1999.0082 Get rights and content

Abstract

Chronic pelvic pain (CPP) is a common and debilitating condition, and yet remarkably little is known about what causes the pain. In this chapter we present a model of CPP which emphasizes the multifactorial nature of the problem. A range of physical causes are discussed, including endometriosis, pelvic inflammatory disease (PID), adhesions, irritable bowel syndrome, interstitial cystitis, musculo-skeletal factors and nerve-related pain. The role of the nervous system in the genesis and moderation of pain is explored. The importance of psychological factors is discussed, both as a primary cause of pain and as a factor which affects the pain experience. As with other chronic syndromes, the biopsychosocial model offers a way of integrating physical causes of pain with psychological and social factors

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Patients presenting for gynecologic surgery are a heterogeneous group. Preoperative quality of life may be a useful tool to guide postoperative management.
This study aimed to examine the key drivers of preoperative quality of life to improve counseling and postoperative management.
This study analyzed preoperative survey results from 154 participants using the following surveys: National Institutes of Health Toolbox Global Health v1.2, Gastrointestinal: Gas and Bloating v1.1 13a, Gastrointestinal: Diarrhea v1.0 6a, and Sexual Function and Satisfaction Brief Profile (Female) v2.0, Perceived Stress Scale, the Vaginal Assessment Scale, and the Vulvar Assessment Scale. Survey results in the form of T-scores were compared in patients with endometrial cancer and patients with benign gynecologic conditions using the Kruskal-Wallis test. The multivariate analysis was performed using linear regression to adjust the comparisons for age, body mass index, and comorbidity.
Of the 154 patients, preoperative diagnosis was benign in 66% (n=102) and endometrial cancer in 34% (n=52). Patients with endometrial cancer were more likely to be older, non-White, in lower income brackets, have higher body mass index, and be postmenopausal (P<.05). Although preoperative global health scores were similar between benign and malignant cases (P>.05), when adjusted for age, the differences in global health quality of life between patients with benign gynecologic conditions and those with endometrial cancer became significant, because the endometrial cancer group was older than the benign group (P<.05). However, when adjusting for age, body mass index, and comorbidities (hypertension and diabetes), the differences were no longer significant (P>.05). Sexual interest was decreased in the patients with endometrial cancer both in the unadjusted and adjusted model; and vulvar complaints became significantly different between the groups when controlling for body mass index, age, and comorbidities (P<.05).
Despite substantial differences in preoperative diagnosis, preoperative quality of life is highly influenced by age, body mass index, and comorbidities. Therefore, these factors should be explored in surgical outcomes and postoperative management trials.
Peripheral Nerve Stimulation for Chronic Pelvic Pain
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Chronic pelvic pain is a common pain complaint in the outpatient clinic setting. There are several common etiologies of chronic pelvic pain, including pudendal, genitofemoral, ilioinguinal, and iliohypogastric neuralgias, among others. When medications or complementary therapies are unsuccessful or not tolerated, providers may consider interventional techniques, such as local anesthetic and/or steroid injections and peripheral nerve stimulation. Peripheral nerve stimulation may be particularly useful when the response to the injection is helpful but short-lived. When planning for peripheral nerve stimulation for pelvic pain there are several considerations, such as depth of the peripheral nerve target and patch location. Due to the anatomy of some peripheral nerves involved in pelvic pain, peripheral nerve stimulation may not be possible percutaneously, or appropriate patch locations may be limited due to body creases, pubic hair, and typical locations of clothing and undergarments.
Sexual Satisfaction and Frequency of Orgasm in Women With Chronic Pelvic Pain due to Endometriosis
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Dyspareunia, one of the main symptoms of the chronic gynecological pelvic pain disorder endometriosis, may interfere with the likelihood of reaching an orgasm, yet for women with dyspareunia, no data on orgasm rates in different sexual activities are available.
The aim of this study was to evaluate the ability to reach an orgasm and its association with sexual satisfaction during different sexual activities in women with a chronic pelvic pain disorder and in healthy control women.
A set of questionnaires including the brief index of sexual functioning and global sexual functioning was used to evaluate sexuality in women affected with endometriosis (n = 434) and a nonaffected control group (n = 434) recruited in German-speaking countries.
The primary outcome measure of this study was the orgasm rate during different types of sexual activities.
Only the ability to have an orgasm during sexual intercourse (P = .002) but not during masturbation (P = .509) or partnered noncoital sexual activities (P = .229) is affected by endometriosis. Dyspareunia was associated with a reduced ability to experience an orgasm during intercourse for endometriosis patients (P = .020) and control women (P = .006). The ability to orgasm during noncoital sexual activities (P = .006) and sexual intercourse (P = .038) was associated with a higher sexual satisfaction in women with endometriosis. For controls, only the ability to achieve an orgasm with sexual intercourse was associated with sexual satisfaction (P = .038).
Sexual counselling as part of medical support could help couples living with chronic pelvic pain of the female partner integrate noncoital sexual activities in their sex lives, leading to fewer sex-related problems and higher sexual desire and satisfaction.
This study is the first to examine different ways of achieving an orgasm and sexual satisfaction in a large group of women with endometriosis and a matched control group. The breadth of the questionnaire allowed a differentiated analysis of factors influencing the likelihood of achieving an orgasm and overall sexual satisfaction. The one limitation is that the length and the intimate nature of the questionnaire possibly resulted in reluctance to answer this part of the questionnaire.
Partnered noncoital sexual activities may represent an alternative to reach orgasm for women with endometriosis-related chronic pelvic pain or anorgasmia during sexual intercourse.
Hämmerli S, Kohl-Schwartz A, Imesch P, et al. Sexual Satisfaction and Frequency of Orgasm in Women With Chronic Pelvic Pain due to Endometriosis. J Sex Med 2020;17:2417–2426.
Sigmoid cancer mimicking ovarian echotexture on transvaginal ultrasound: Case report with literature review
2020, Radiology Case Reports
Ultrasound is a first line imaging modality for the evaluation of female pelvic pain. Pelvic pain constitutes one of the most common reasons for presentation to the emergency department with increasing use of point of care ultrasound. Infrequently, point of care or formal ultrasound evaluation may lead to misdiagnosis of extraovarian disease. This can have serious consequences, especially if an extraovarian malignancy is mistaken for a normal ovary or an ovary with a benign process. We present a case of a 41-year-old female who presented to the emergency department for a chief complaint of pelvic pain and vaginal bleeding. Transvaginal ultrasound demonstrated a left adnexal mass, later characterized as a sigmoid colon cancer on MRI and pathology, simulating ovarian echotexture with peripheral hypoechoic components resembling follicles. This article will review the literature of various cases of extraovarian pathology misidentified as ovarian processes and highlight the importance of considering these extraovarian mimickers to prevent potential morbidity and mortality of a missed diagnosis.
Incidence of postural disorders in patients with chronic pelvic-perineal pain
2018, Progres en Urologie
Les algies pelvipérinéales s’accompagnant souvent de douleurs musculaires du périnée et des muscles pelvitrochantériens, nous avons cherché à observer la fréquence des troubles de la posture en lien avec les muscles pelvipérinéaux chez des patients consultant pour des algies pelvipérinéales par rapport à une population témoin exempte de ces douleurs.
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Au total, 51 sujets étaient inclus dans l’étude et divisés en deux populations : 26 patients, 25 témoins. Le syndrome de la charnière thoracolombaire était retrouvé chez 28 % des patients vs 4 % des témoins (p = 0,024) ; les syndromes myofasciaux étaient présents chez 68 % des patients vs 25 % des témoins (p = 0,005) ; l’instabilité pelvienne concernait 76 % des patients vs 33 % des témoins (p = 0,002) ; les dysfonctions du quadrilatère pelvipédieux concernaient 96 % des patients vs 58 % des témoins (p = 0,001) ; l’hypertonie musculaire paravertébrale était retrouvée bilatéralement chez 32 % des patients vs 4 % des témoins (p = 0,077) et unilatéralement chez 36 % des patients vs 0 % des témoins (p = 0,001).
Les patients présentant des douleurs pelvipérinéales chroniques présentaient de façon significative plus de troubles de la posture que les patients non douloureux. Il nous paraissait pertinent que le bilan postural soit intégré à leur examen clinique habituel.
4.
Pelvic-perineal pain often accompanied by pain of the perineum and pelvi-trochanteric muscles, we sought to observe the frequency of postural disturbances in relation to the pelvi-perineal muscles in patients who consult for pelvic perineal pain compared to a control population free of these pain.
The prospective monocentric study was conducted during consultations of pelvic perineal pain in the urology department of Nantes and was based on 5 clinical tests successively looking for the presence of thoraco-lumbar hinge syndrome, myofascial syndrome in the pelvic diaphragm, pelvic instability, pelvic-pedic quadrilateral dysfunction and paravertebral muscle hypertonia.
A total of 51 subjects were included in the study and divided into two populations: 26 patients, 25 controls. Thoraco-lumbar hinge syndrome was found in 28 % of patients vs 4 % of controls (P = 0.024); myofascial syndromes were present in 68 % of patients vs 25 % of controls (P = 0.005); pelvic instability concerned 76 % of patients vs 33 % of controls (P = 0.002); the dysfunctions of the pelvic-pedic quadrilateral concerned 96 % of the patients vs 58 % of the controls (P = 0.001); paravertebral muscle hypertonia was found bilaterally in 32 % of patients vs 4 % of controls (P = 0.077) and unilaterally in 36 % of patients vs 0 % of controls (P = 0.001).
Patients with chronic pelvic perineal pain had significantly more posture problems than non-pain patients. It seemed relevant to us that the postural assessment was integrated into their usual clinical examination.
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Citation Excerpt :
Although in the posterior mesh, the arms will in addition travel through the ischiorectal fossa and terminate in the sacrospinous ligament.18 It is important to excise as much mesh as possible when removing the mesh for the indication of pelvic pain.19 Once maximal mesh excision is achieved, the bladder and rectum integrity is checked with repeat cystoscopy with dye to exclude ureteric injury and a rectal examination, respectively.

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Regular ArticleCauses of chronic pelvic pain

Abstract

Fertility and Sterility

British Journal of Anaesthesia

American Journal of Obstetrics and Gynecology

American Journal of Obstetrics and Gynecology

American Journal of Obstetrics and Gynecology

Fertility and Sterility

Fertility and Sterility

American Journal of Obstetrics and Gynecology

Fertility and Sterility

Fertility and Sterility

Fertility and Sterility

Journal of Academic Dermatology

Gastroenterology

Urology

Journal of Urology

Obstetrics and Gynecology Clinics of North America

Urologic Clinics of North American

Journal of Urology

Urology

Obstetrics and Gynecology Clinics of North America

American Journal of Obstetrics and Gynecology

Pain

Pain

Lancet

Pain

Pain

Pain

British Journal of Anaesthesia

American Journal of Obstetrics and Gynecology

Obstetrics and Gynecology

Pain

Mind/body dualism in medicine: the case of chronic pelvic pain without organic pathology

International Journal of Health Sciences

Prevalence and incidence in primary care of chronic pelvic pain in women: evidence from a national general practice database

British Journal of Obstetrics and Gynaecology

The role of laparoscopy in chronic pelvic pain: promise and pitfalls

Obstetrical and Gynecological Survey

Problems of communication, diagnosis, and treatment experienced by women using the New Zealand health services for chronic pelvic pain: a quantitative analysis

Health Care for Women International

Chronic pelvic pain in women: toward an integrative model

Obstetrical and Gynecological Survey

International Journal of Obstetrics and Gynecology

Chronic pelvic pain in women—gastroenterological, gynaecological or psychological

International Journal of Colorectal Disease

Occult somatic pathology in women with chronic pelvic pain

Clinical Obstetrics and Gynecology

Is mild endometriosis a disease?

Human Reproduction

Visible and non-visible endometriosis at laparoscopy in fertile and infertile women and in patients with chronic pelvic pain: a prospective study

Human Reproduction

Regular Article
Causes of chronic pelvic pain