Pelvic pain
Pelvic pain is pain in the area of the pelvis. Acute pain is more common than chronic pain.[2] If the pain lasts for more than six months, it is deemed to be chronic pelvic pain.[3][4] It can affect both the male and female pelvis.
Pelvic and perineal pain
43% worldwide[1]
Common causes in include: endometriosis in women, bowel adhesions, irritable bowel syndrome, and interstitial cystitis.[5][6] The cause may also be a number of poorly understood conditions that may represent abnormal psychoneuromuscular function.
The role of the nervous system in the genesis and moderation of pain is explored.[7] 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.[8]
Terminology[edit]
Pelvic pain is a general term that may have many causes, listed below.
The subcategorical term urologic chronic pelvic pain syndrome (UCPPS) is an umbrella term adopted for use in research into urologic pain syndromes associated with the male and female pelvis.[9] UCPPS specifically refers to chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) in men and interstitial cystitis or painful bladder syndrome (IC/PBS) in women.[10]
Diagnosis[edit]
Females[edit]
The absence of visible pathology in chronic pain syndromes should not form the basis for either seeking psychological explanations or questioning the reality of the patient’s pain.[14] Instead it is essential to approach the complexity of chronic pain from a psychophysiological perspective which recognises the importance of the mind-body interaction. Some of the mechanisms by which the limbic system impacts on pain, and in particular myofascial pain, have been clarified by research findings in neurology and psychophysiology.[15]
Epidemiology[edit]
Female[edit]
Most women, at some time in their lives, experience pelvic pain. As girls enter puberty, pelvic or abdominal pain becomes a frequent complaint.
Chronic pelvic pain is a common condition with rate of dysmenorrhoea between 16.8 and 81%, dyspareunia between 8-21.8%, and noncyclical pain between 2.1 and 24%.[30]
According to the CDC, Chronic pelvic pain (CPP) accounted for approximately 9% of all visits to gynecologists in 2007.[31] In addition, CPP is the reason for 20-30% of all laparoscopies in adults.[32] Pelvic girth pain is frequent during pregnancy.[33]
Social implications[edit]
Issues have been found in current procedures for the treatment of chronic pelvic pain (CPP). These relate primarily with regard to the conceptual dichotomy between an ‘organic’ genesis of pain, where the presence of tissue damage is presumed, and a ‘psychogenic’ origin, where pain occurs despite a lack of damage to tissue.[34] CPP literature in medicine and psychiatry reflects a paradigm where unproblematically observable ‘organic’ processes are causally and sequentially explained, despite evidence in favour of a possible model which accounts for the “complex role played by meaning and consciousness” in the experience of pain.[34] While in the literature of causal mechanisms reference is made to ‘subjective’ aspects of pain, current models do not provide a means through which these aspects may be accessed or understood.[34] Without interpretive or ‘subjective’ approaches to the pain experienced by patients, medical understandings of CPP are fixed within ‘organic’ sequences of the “purely object” body conceptually separated from the patient.[34] Despite the prevalence of this wider understanding of the biological genesis of pain, alternate diagnosis and treatments of CPP in multidisciplinary settings have shown high success rates for people for whom ‘organic’ pathology has been unhelpful.[34]