Materiały źródłowe

• #1 Epidemiology of Chronic Pelvic Pain | SpringerLink

  https://link.springer.com/10.1007%2F978-3-642-28753-4_1333

  Chronic pelvic pain, epidemiology; Pelvic pain syndrome; Recurrent pelvic pain […] The most commonly used definition of chronic pelvic pain (CPP) for research purposes is Recurrent or constant pain in the lower abdominal region that has lasted for at least 6 months. […] The International Association for the Study of Pain (1986) defines CPP without obvious pathology (CPPWOP) as chronic or recurrent pelvic pain that cannot be sufficiently explained by an apparent physical cause. […] The definition assumes a causal link between pelvic pathology and pain, which clinical experience and the published literature would suggest is not always the case. […] Since then, two further definitions have been suggested. […] The American College of Obstetricians and Gynecologists (2004) has proposed a definition of CPP as non-cyclical pain of at least 6 months duration that appears in locations such as the pelvis, anterior abdominal wall, lower back, or buttocks, and that is serious enough to…

• #1 Prevalence of chronic pelvic pain among women: an updated review – PubMed

  https://pubmed.ncbi.nlm.nih.gov/24658485/

  Chronic pelvic pain (CPP), defined as a noncyclical pain lasting for more than 6 months can lead to lower physical performance and quality of life in women. CPP is a worldwide problem affecting women of all ages. […] Based on these articles, prevalence in general ranged between 5.7% and 26.6%. There were many countries and regions without basic data in the field of CPP. This review shows the paucity of studies, especially multidisciplinary researches with multifactorial views on CPP. Multidisciplinary studies would provide more reliable data for estimating the prevalence of CPP and its psycho-socioeconomic burden, as well as finding its etiologies and characteristics.

• #2 Prevalence of chronic pelvic pain among women: an updated review – PubMed

  https://pubmed.ncbi.nlm.nih.gov/24658485/

  Chronic pelvic pain (CPP), defined as a noncyclical pain lasting for more than 6 months can lead to lower physical performance and quality of life in women. CPP is a worldwide problem affecting women of all ages. […] Based on these articles, prevalence in general ranged between 5.7% and 26.6%. There were many countries and regions without basic data in the field of CPP. This review shows the paucity of studies, especially multidisciplinary researches with multifactorial views on CPP. Multidisciplinary studies would provide more reliable data for estimating the prevalence of CPP and its psycho-socioeconomic burden, as well as finding its etiologies and characteristics.

• #2 Chronic Pelvic Pain in Women: Background, Etiology, Epidemiology

  https://emedicine.medscape.com/article/258334-overview

  Chronic pelvic pain is a common problem. It affects approximately 1 in 7 women. […] In one study of reproductive-aged women in primary care practices, the reported prevalence rate of pelvic pain was 39%. […] Of all referrals to gynecologists, 10% are for pelvic pain. […] A similar prevalence of chronic pelvic pain has been described in other countries. […] In one study, Blacks had a higher incidence of pelvic pain. […] Chronic pelvic pain is most common among reproductive-aged women. […] Chronic pelvic pain is most common among reproductive-aged women, especially those aged 26-30 years.

• #3 Chronic Pelvic Pain | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/26872

  Chronic pelvic pain is a persistent, disabling, or cyclic intermittent pain within the pelvis, most commonly affecting women. In the United States, 1 in 7 women are affected by this condition. Chronic pelvic pain affects approximately 4% to 16% of women. The prevalence of chronic pelvic pain is similar to that of migraine headaches, asthma, and chronic back pain. Chronic pelvic pain primarily affects women, but it accounts for 2% to 16% of cases in men. The overall prevalence of chronic pelvic pain among women ranges from about 4% to 16%. Despite this, only 33% of affected women seek medical care. […] Around 35% of patients with chronic pelvic pain have comorbid IBS. An estimated 61% of women with bladder pain syndrome have comorbid chronic pelvic pain, and nearly 50% of women with endometriosis report chronic pelvic pain. Gynecological comorbidities are present in approximately 20% of patients with chronic pain. Among patients with chronic pelvic pain who undergo elective surgery, 20% to 80% are found to have endometriosis. Conversely, approximately 70% of individuals with a prior diagnosis of endometriosis go on to develop chronic pelvic pain.

• #4 EAU Guidelines on Chronic Pelvic Pain – Uroweb

  https://uroweb.org/guidelines/chronic-pelvic-pain/chapter/epidemiology-aetiology-and-pathophysiology

  Chronic pelvic pain has been shown to be one of the most common functional disorders in women of reproductive age. The monthly incidence rate of CPPPS published by Zondervan et al. was 1.58/1000. […] The monthly prevalence rate of CPPPS in this study was 21.5/1,000, with an annual prevalence of 38.3/1,000. […] The prevalence rates increase significantly with older age and vary significantly between regions in the UK.

• #5 Chronic Pelvic Pain in Women: Background, Etiology, Epidemiology

  https://emedicine.medscape.com/article/258334-overview

  Chronic pelvic pain is a common problem. It affects approximately 1 in 7 women. […] In one study of reproductive-aged women in primary care practices, the reported prevalence rate of pelvic pain was 39%. […] Of all referrals to gynecologists, 10% are for pelvic pain. […] A similar prevalence of chronic pelvic pain has been described in other countries. […] In one study, Blacks had a higher incidence of pelvic pain. […] Chronic pelvic pain is most common among reproductive-aged women. […] Chronic pelvic pain is most common among reproductive-aged women, especially those aged 26-30 years.

• #6 Chronic Pelvic Pain | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/26872

  Chronic pelvic pain is a persistent, disabling, or cyclic intermittent pain within the pelvis, most commonly affecting women. In the United States, 1 in 7 women are affected by this condition. Chronic pelvic pain affects approximately 4% to 16% of women. The prevalence of chronic pelvic pain is similar to that of migraine headaches, asthma, and chronic back pain. Chronic pelvic pain primarily affects women, but it accounts for 2% to 16% of cases in men. The overall prevalence of chronic pelvic pain among women ranges from about 4% to 16%. Despite this, only 33% of affected women seek medical care. […] Around 35% of patients with chronic pelvic pain have comorbid IBS. An estimated 61% of women with bladder pain syndrome have comorbid chronic pelvic pain, and nearly 50% of women with endometriosis report chronic pelvic pain. Gynecological comorbidities are present in approximately 20% of patients with chronic pain. Among patients with chronic pelvic pain who undergo elective surgery, 20% to 80% are found to have endometriosis. Conversely, approximately 70% of individuals with a prior diagnosis of endometriosis go on to develop chronic pelvic pain.

• #7 Chronic orchialgia: epidemiology, diagnosis and evaluation – Sigalos – Translational Andrology and Urology

  https://tau.amegroups.org/article/view/14934/html

  Chronic pelvic pain syndromes more generally have been better characterized and studied in women than in men. Chronic pelvic pain affects approximately 15% of women 18-50 years old. In contrast, a recent study of 900 Swedish men estimated that chronic pelvic pain only affects 3-5% of men 40-69 years old. The differential diagnosis of chronic pelvic pain includes scrotal and testicular pain. Zermann observed that 38.8% of cases of chronic pelvic pain in men localize to the scrotum. A Swedish study that surveyed how urologists treat chronic scrotal pain estimated that 2.5% of visits are for chronic scrotal pain, given that urologists on average self-reported 6.5 new patient visits with a primary diagnosis of chronic scrotal pain monthly. A more recent study observed chronic scrotal pain in 4.8% (113/2,375) of men who presented to an outpatient urologist.

• #8 Chronic Pelvic Pain in Men: Practice Essentials, Etiology, Epidemiology

  https://emedicine.medscape.com/article/437745-overview

  In the United States, chronic prostatitis (CP) is the most common urologic diagnosis in men older than age 50 years and is the third most common diagnosis in men younger than age 50 years. This diagnosis results in at least 2 million office visits per year. The average urologist sees approximately 10 patients with prostatitis per month, 30% of whom are new patients. Specific urinary pathogens are detected infrequently after culture. The vast majority of these patients are categorized as having chronic nonbacterial prostatitis, that is, CPPS.

• #9 Definition and epidemiology of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) | Publisso

  https://series.publisso.de/en/publisso_gold/publishing/books/overview/52/103

  Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a complex of symptoms including urological pain, with or without voiding symptoms. The prevalence is relatively similar across continents raising the possibility that the cause is not dependent on environment. […] A recent review for the International Consultation on Urologic Disease (ICUD) sponsored by the Societ Internationale d’Urologie indicated that prevalence of prostatitis-like symptoms ranged from 2.2% to 16%, with a median prevalence rate approximating 7.1% for chronic prostatitis/chronic pelvic pain syndrome. The mean prevalence in studies according to continent of origin ranged from 6.9% in North America to 12.2% in Africa, with Europe at 8.6%, 7.5% in Asia, and 7.6% in Australia. […] The NIH (U.S.) sponsored Multidisciplinary Approach to Pelvic Pain (MAPP) study has provided insights in to other aspects of the epidemiology of men with chronic pelvic pain who can be classified as CP/CPPS. Of 191 men enrolled in the first MAPP study, 75% were found to have either pain urgency, i.e. urgency to urinate due to pain pressure or discomfort and not due to fear of leaking, or pain that was made worse with bladder filling. […] The phenotype of patients meeting the criteria for CPPS is variable and can include several different types of symptoms. This has been well outlined by Shoskes and colleagues in the UPOINT classification.

• #10 Chronic Pelvic Pain in Women: Background, Etiology, Epidemiology

  https://emedicine.medscape.com/article/258334-overview

  Chronic pelvic pain is a common problem. It affects approximately 1 in 7 women. […] In one study of reproductive-aged women in primary care practices, the reported prevalence rate of pelvic pain was 39%. […] Of all referrals to gynecologists, 10% are for pelvic pain. […] A similar prevalence of chronic pelvic pain has been described in other countries. […] In one study, Blacks had a higher incidence of pelvic pain. […] Chronic pelvic pain is most common among reproductive-aged women. […] Chronic pelvic pain is most common among reproductive-aged women, especially those aged 26-30 years.

• #11 The Underestimated Prevalence of Neglected Chronic Pelvic Pain in Women, a Nationwide Cross-Sectional Study in France

  https://www.mdpi.com/2077-0383/10/11/2481

  The CONSTANCES cohort study, designed for several epidemiological purposes, provides a new French database of information collected from the general population of France. This nationwide cohort fits our objective of estimating the prevalence of dysmenorrhea, dyspareunia, and NMCPP among women in the general population, according to their severity and overlapping relations. We further hypothesize that these three types of chronic pelvic pain are highly prevalent symptoms and that their prevalence may be different according to age. The possibility that women may present more than one of these symptoms at the same time underlines the importance of examining their interrelations. […] In our sample, young women were more likely than their older counterparts to report severe dysmenorrhea. A similar linear age relation was observed for the frequency of dyspareunia. The prevalence of NMCPP increased until it reached its highest level among women aged 30–34 years and then decreased. Overall, our finding that 7.5% of the women in this cohort experienced two or more types of severe or frequent chronic pelvic pain suggests that chronic pelvic pain might well be a substantial health issue in the general population of premenopausal French women.

• #12 Chronic Pelvic Pain in Women: Background, Etiology, Epidemiology

  https://emedicine.medscape.com/article/258334-overview

  Chronic pelvic pain is a common problem. It affects approximately 1 in 7 women. […] In one study of reproductive-aged women in primary care practices, the reported prevalence rate of pelvic pain was 39%. […] Of all referrals to gynecologists, 10% are for pelvic pain. […] A similar prevalence of chronic pelvic pain has been described in other countries. […] In one study, Blacks had a higher incidence of pelvic pain. […] Chronic pelvic pain is most common among reproductive-aged women. […] Chronic pelvic pain is most common among reproductive-aged women, especially those aged 26-30 years.

• #13 Endometriosis: Epidemiology, Classification, Pathogenesis, Treatment and Genetics (Review of Literature)

  https://www.mdpi.com/1422-0067/22/19/10554

  The risk of developing endometriosis is the lowest in black women, the highest in Asian women. Caucasian women have a higher risk of getting sick than black women. […] Endometriosis is a problem of enormous importance not only from the medical and social angles but also from an economic point of view. The annual costs of endometriosis treatment in Europe range from €0.8 billion to €12.5 billion depending on the country and are comparable to other chronic diseases such as diabetes. […] Literature data indicate that endometriosis is found in 0.1–53% of women operated on laparoscopically or by laparotomy, of which 12–32% are women after diagnostic laparoscopy due to pelvic pain delays and 10–60% of the patient after diagnostic laparoscopy due to disability. […] The time from the appearance of the first symptoms of the disease to the diagnosis is up to 8 to 10 years.

• #14 Chronic Pelvic Pain | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/26872

  Chronic pelvic pain is a persistent, disabling, or cyclic intermittent pain within the pelvis, most commonly affecting women. In the United States, 1 in 7 women are affected by this condition. Chronic pelvic pain affects approximately 4% to 16% of women. The prevalence of chronic pelvic pain is similar to that of migraine headaches, asthma, and chronic back pain. Chronic pelvic pain primarily affects women, but it accounts for 2% to 16% of cases in men. The overall prevalence of chronic pelvic pain among women ranges from about 4% to 16%. Despite this, only 33% of affected women seek medical care. […] Around 35% of patients with chronic pelvic pain have comorbid IBS. An estimated 61% of women with bladder pain syndrome have comorbid chronic pelvic pain, and nearly 50% of women with endometriosis report chronic pelvic pain. Gynecological comorbidities are present in approximately 20% of patients with chronic pain. Among patients with chronic pelvic pain who undergo elective surgery, 20% to 80% are found to have endometriosis. Conversely, approximately 70% of individuals with a prior diagnosis of endometriosis go on to develop chronic pelvic pain.

• #15 Chronic Pelvic Pain | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/26872

  Chronic pelvic pain is a persistent, disabling, or cyclic intermittent pain within the pelvis, most commonly affecting women. In the United States, 1 in 7 women are affected by this condition. Chronic pelvic pain affects approximately 4% to 16% of women. The prevalence of chronic pelvic pain is similar to that of migraine headaches, asthma, and chronic back pain. Chronic pelvic pain primarily affects women, but it accounts for 2% to 16% of cases in men. The overall prevalence of chronic pelvic pain among women ranges from about 4% to 16%. Despite this, only 33% of affected women seek medical care. […] Around 35% of patients with chronic pelvic pain have comorbid IBS. An estimated 61% of women with bladder pain syndrome have comorbid chronic pelvic pain, and nearly 50% of women with endometriosis report chronic pelvic pain. Gynecological comorbidities are present in approximately 20% of patients with chronic pain. Among patients with chronic pelvic pain who undergo elective surgery, 20% to 80% are found to have endometriosis. Conversely, approximately 70% of individuals with a prior diagnosis of endometriosis go on to develop chronic pelvic pain.

• #16

  https://www.who.int/news-room/fact-sheets/detail/endometriosis

  Endometriosis affects roughly 10% (190 million) of reproductive age women and girls globally. […] It is a chronic disease associated with severe, life-impacting pain during periods, sexual intercourse, bowel movements and/or urination, chronic pelvic pain, abdominal bloating, nausea, fatigue, and sometimes depression, anxiety, and infertility. […] Endometriosis often causes severe pain in the pelvis, especially during menstrual periods. […] Some people also experience chronic pelvic pain. […] A careful history of menstrual symptoms and chronic pelvic pain provides the basis for suspecting endometriosis. […] In many countries, the general public and most front-line healthcare providers are not aware that distressing and life-altering pelvic pain is not normal, leading to a normalization and stigmatization of symptoms and significant diagnostic delay.

• #17 Chronic pelvic pain: epidemiology and risk factors – Eesti Arst – Eesti Arstide Liidu ajakiri

  https://eestiarst.ee/en/chronic-pelvic-pain-epidemiology-and-risk-factors/

  Chronic pelvic pain (CPP) is a common condition in women that is hard to diagnose. The epidemiology of CPP is very difficult to investigate because of: 1) lack of consensus regarding its clinical definition across studies; 2) its multi-causal origin; and 3) study design complications. Using the most common definition of CPP (lower abdominal pain of at least 6 month`s duration, excluding pain solely related to pregnancy, menstruation, or intercourse), the prevalence of CPP among women of reproductive age in general population is estimated to be as high as 25%. […] Investigation of the aetiology of CPP through assessment of risk factors remains highly complicated because of the complexity of the condition. Half the women with chronic pelvic pain also have either genitourinary or irritable bowel syndrome, or both. Prevalence of dysmenorrhea and dyspareunia is higher among women with CPP than among women without chronic pelvic pain. […] Irritable bowel syndrome and stress were the most common diagnoses received by patients with chronic pelvic pain, but in 50% the diagnosis was never made.

• #18 Part 1: Understanding chronic pelvic pain

  https://bpac.org.nz/bpj/2015/september/pelvic.aspx

  Women with chronic pelvic pain also have a higher incidence of other chronic pain syndromes, such as bladder pain syndrome (interstitial cystitis) and fibromyalgia, as well as irritable bowel syndrome. […] Many conditions associated either with specific pathology, a chronic pain syndrome, or components of both can produce or contribute to chronic pelvic pain. […] A multi-disciplinary approach to women with chronic pelvic pain aims to consider the possibility of the many aetiologies that may be producing the pain, and subsequent sequelae such as low mood and emotional, behavioural and sexual consequences. […] The primary aims of investigations are to rule out infection and to detect the presence of any other underlying organic pathology. […] Many women with chronic pelvic pain will go on to have a diagnostic laparoscopy if no cause for their pain has been found. […] Treatment should focus on the often complex contributory factors rather than on a single pathological process.

• #19 Chronic Pelvic Pain | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/26872

  Patients with a history of pelvic trauma or surgery are at a significantly higher risk of developing chronic pelvic pain compared to the general population. Approximately 28% of women experience persistent pelvic pain 3 months after an elective cesarean delivery, with 20% continuing to have persistent pain 6 months postoperatively. Nearly 50% of women with chronic pelvic pain report a previous history of sexual or physical abuse. Furthermore, among patients with both a history of abuse and chronic pelvic pain, one-third also have comorbid PTSD. Up to 30% of women with a prior history of pelvic inflammatory disease go on to develop chronic pelvic pain. […] Chronic pelvic pain is commonly associated with conditions such as IBS, interstitial cystitis, and chronic fatigue syndrome, all of which are classified as overlapping chronic pain conditions. Chronic pelvic pain is strongly associated with mental health disorders, including posttraumatic stress disorder (PTSD) and major depressive disorder. In more than half of chronic pelvic pain cases, comorbid conditions such as endometriosis, pelvic adhesions, IBS, or interstitial cystitis are present.

• #20 Chronic Pelvic Pain | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/26872

  Patients with a history of pelvic trauma or surgery are at a significantly higher risk of developing chronic pelvic pain compared to the general population. Approximately 28% of women experience persistent pelvic pain 3 months after an elective cesarean delivery, with 20% continuing to have persistent pain 6 months postoperatively. Nearly 50% of women with chronic pelvic pain report a previous history of sexual or physical abuse. Furthermore, among patients with both a history of abuse and chronic pelvic pain, one-third also have comorbid PTSD. Up to 30% of women with a prior history of pelvic inflammatory disease go on to develop chronic pelvic pain. […] Chronic pelvic pain is commonly associated with conditions such as IBS, interstitial cystitis, and chronic fatigue syndrome, all of which are classified as overlapping chronic pain conditions. Chronic pelvic pain is strongly associated with mental health disorders, including posttraumatic stress disorder (PTSD) and major depressive disorder. In more than half of chronic pelvic pain cases, comorbid conditions such as endometriosis, pelvic adhesions, IBS, or interstitial cystitis are present.

• #21 Chronic Pelvic Pain | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/26872

  Chronic pelvic pain is a persistent, disabling, or cyclic intermittent pain within the pelvis, most commonly affecting women. In the United States, 1 in 7 women are affected by this condition. Chronic pelvic pain affects approximately 4% to 16% of women. The prevalence of chronic pelvic pain is similar to that of migraine headaches, asthma, and chronic back pain. Chronic pelvic pain primarily affects women, but it accounts for 2% to 16% of cases in men. The overall prevalence of chronic pelvic pain among women ranges from about 4% to 16%. Despite this, only 33% of affected women seek medical care. […] Around 35% of patients with chronic pelvic pain have comorbid IBS. An estimated 61% of women with bladder pain syndrome have comorbid chronic pelvic pain, and nearly 50% of women with endometriosis report chronic pelvic pain. Gynecological comorbidities are present in approximately 20% of patients with chronic pain. Among patients with chronic pelvic pain who undergo elective surgery, 20% to 80% are found to have endometriosis. Conversely, approximately 70% of individuals with a prior diagnosis of endometriosis go on to develop chronic pelvic pain.

• #22 Chronic Pelvic Pain – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK554585/

  Chronic pelvic pain primarily affects women, but it accounts for 2% to 16% of cases in men. […] The overall prevalence of chronic pelvic pain among women ranges from about 4% to 16%. Despite this, only 33% of affected women seek medical care. […] Chronic pelvic pain affects approximately 4% to 16% of women. […] Around 35% of patients with chronic pelvic pain have comorbid IBS. An estimated 61% of women with bladder pain syndrome have comorbid chronic pelvic pain, and nearly 50% of women with endometriosis report chronic pelvic pain. […] Gynecological comorbidities are present in approximately 20% of patients with chronic pain. […] Among patients with chronic pelvic pain who undergo elective surgery, 20% to 80% are found to have endometriosis. Conversely, approximately 70% of individuals with a prior diagnosis of endometriosis go on to develop chronic pelvic pain. […] Patients with a history of pelvic trauma or surgery are at a significantly higher risk of developing chronic pelvic pain compared to the general population. […] Up to 30% of women with a prior history of pelvic inflammatory disease go on to develop chronic pelvic pain.

• #23 EAU Guidelines on Chronic Pelvic Pain – Uroweb

  https://uroweb.org/guidelines/chronic-pelvic-pain/chapter/epidemiology-aetiology-and-pathophysiology

  Studies about integrating the psychological factors of CPPPSs are few but the quality is high. Psychological factors are consistently found to be relevant in the maintenance of persistent pelvic and urogenital pain. […] The only SR of risk factors for chronic non-cyclical pelvic pain in women included, as well as medical variables: sexual or physical abuse; psychological problems such as anxiety and depression; multiple somatic problems. […] Many studies have reported high rates of childhood sexual abuse in adults with persistent pain, particularly in women with pelvic pain. […] The mechanisms that serve as an underlying cause for chronic pelvic pain are ongoing acute pain mechanisms, chronic pain mechanisms, and emotional, cognitive, behavioural and sexual responses and mechanisms. […] Symptoms and signs of neuropathic pain appear to be common in CPPPS patients and assessment of neuropathic pain should be considered in that group of patients including those with secondary pelvic pain and other pelvic pathologies.

• #24 The burden of Chronic Pelvic Pain (CPP): Costs and quality of life of women and men with CPP treated in outpatient referral centers | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0269828

  A 2021 systematic review of women with CPP calculated the direct yearly cost per woman to be between $16,970 to $20,898, this includes healthcare, prescription, and indirect costs (lost wages and reduced productivity). […] For men with CPP, a Northwestern University outpatient urology clinic calculated annual direct costs (via Medicare rates and non-Medicare reimbursements) and lost wages due to absenteeism. […] There is a strong psychosocial impact as CPP patients are affected by anxiety and depression at strikingly higher rates than the general population. […] CPP represents a significant individual and societal burden and although researchers discuss the substantial psychosocial and economic impact, a precise figure is difficult to determine due to the lack of multidisciplinary studies and limited understanding/consensus regarding CPP among researchers and health providers. […] In conclusion, Chronic Pelvic Pain was found to have a large cost burden of $29,951 for in-network services which includes treatments, diagnostics, and surgeries.

• #25 The burden of Chronic Pelvic Pain (CPP): Costs and quality of life of women and men with CPP treated in outpatient referral centers | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0269828

  Chronic Pelvic Pain (CPP) is a complex, multifaceted condition that affects both women and men. There is limited literature on the cost utilization the healthcare system and CPP patients incur. The purpose of this analysis is to characterize the overall healthcare utilization, cost burden, and quality-of-life restrictions experienced by CPP patients using data from an outpatient pelvic rehabilitation practice. […] About 14% percent of women experience CPP during their life. Urological chronic pelvic pain syndrome (UCPPS) affects 2%-16% of men worldwide. […] Direct costs associated with CPP, related organ system dysfunctions, and the indirect costs of productivity loss, absenteeism, and missed wages are significant. […] A study analyzing 5,879 women diagnosed with Endometriosis discovered a positive correlation between symptom severity and hours of employment productivity lost: women with mild severity reported a weekly loss of 1.9 hours compared to 15.8 hours lost for severe symptoms.

• #26 Incidence of Chronic Pelvic Pain in Females Attending a Gynaecology Outpatient Department – European Medical Journal

  https://www.emjreviews.com/flagship-journal/article/incidence-of-chronic-pelvic-pain-in-females-attending-a-gynaecology-outpatient-department/

  Chronic pelvic pain (CPP) is a persistent pelvic pain that leads to reduced work performance and impaired quality of life in females. Nearly 15% of females report time off from paid work and around 45% report reduced work productivity. […] Chronic pelvic pain (CPP) affects up to 25% of females of reproductive age, and 15% of all females worldwide. It is a common complaint of females visiting the gynaecology outpatient department. The annual prevalence of CPP was found to be 38/1,000, a rate comparable to asthma (37/1,000) and back pain (41/1,000). […] The frequency of CPP in females was observed as 95.52% (95% confidence interval: 91.67-97.93%). The rate of CPP was significantly high in females with parity 5 and those who had a duration of pain lower than 36 months. […] The study indicates that the most common gynaecological causes of CPP in females attending the outpatient department were those with endometriosis followed by adenomyosis.

• #27 Incidence of Chronic Pelvic Pain in Females Attending a Gynaecology Outpatient Department – European Medical Journal

  https://www.emjreviews.com/flagship-journal/article/incidence-of-chronic-pelvic-pain-in-females-attending-a-gynaecology-outpatient-department/

  Chronic pelvic pain (CPP) is a persistent pelvic pain that leads to reduced work performance and impaired quality of life in females. Nearly 15% of females report time off from paid work and around 45% report reduced work productivity. […] Chronic pelvic pain (CPP) affects up to 25% of females of reproductive age, and 15% of all females worldwide. It is a common complaint of females visiting the gynaecology outpatient department. The annual prevalence of CPP was found to be 38/1,000, a rate comparable to asthma (37/1,000) and back pain (41/1,000). […] The frequency of CPP in females was observed as 95.52% (95% confidence interval: 91.67-97.93%). The rate of CPP was significantly high in females with parity 5 and those who had a duration of pain lower than 36 months. […] The study indicates that the most common gynaecological causes of CPP in females attending the outpatient department were those with endometriosis followed by adenomyosis.

• #28 The burden of Chronic Pelvic Pain (CPP): Costs and quality of life of women and men with CPP treated in outpatient referral centers | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0269828

  A 2021 systematic review of women with CPP calculated the direct yearly cost per woman to be between $16,970 to $20,898, this includes healthcare, prescription, and indirect costs (lost wages and reduced productivity). […] For men with CPP, a Northwestern University outpatient urology clinic calculated annual direct costs (via Medicare rates and non-Medicare reimbursements) and lost wages due to absenteeism. […] There is a strong psychosocial impact as CPP patients are affected by anxiety and depression at strikingly higher rates than the general population. […] CPP represents a significant individual and societal burden and although researchers discuss the substantial psychosocial and economic impact, a precise figure is difficult to determine due to the lack of multidisciplinary studies and limited understanding/consensus regarding CPP among researchers and health providers. […] In conclusion, Chronic Pelvic Pain was found to have a large cost burden of $29,951 for in-network services which includes treatments, diagnostics, and surgeries.

• #29 Part 1: Understanding chronic pelvic pain

  https://bpac.org.nz/bpj/2015/september/pelvic.aspx

  Chronic pelvic pain is defined as intermittent or constant pain in the lower abdomen or pelvis of at least six months duration, that does not occur exclusively with menstruation or intercourse. […] Women with chronic pelvic pain report a lower quality of life, with high rates of functional impairment, psychosocial distress and sexual dysfunction. […] Chronic pelvic pain can arise from pathology affecting any of the structures located within the pelvis and lower abdomen, as well as other structures related to these areas, e.g. skeletal system, pelvic floor muscles and nerves, or there may be no cause identified. […] Estimates of the prevalence of chronic pelvic pain vary widely depending on the definition used and range from 2% to 27% of adult females worldwide. […] Chronic pelvic pain can arise from pathology affecting any of the structures located within the pelvis and lower abdomen, as well as other structures related to these areas, e.g. skeletal system, pelvic floor muscles and nerves, or there may be no cause identified.

• #30 Clinical profiling of specific diagnostic subgroups of women with chronic pelvic pain | medRxiv

  https://www.medrxiv.org/content/10.1101/2022.10.03.22280515v2.full-text

  Chronic pelvic pain (CPP) is a common condition affecting up to 26.6% of women, with many suffering for several years before diagnosis and/or treatment. […] The study is part of the Translational Research in Pelvic Pain (TRiPP) project which is a cross-sectional observational cohort study. […] Clinical profiles of women with CPP (13-50 years old) show variability of clinical symptoms. […] Scores for the QoL questionnaire (SF-36) reveal that CPP patients had significantly lower QoL across all SF-36 subscales (p0.001). […] Our results demonstrate the negative impact that chronic pain has on CPP patients QoL and reveal an increased negative impact of pain on the comorbid EABP group. […] Chronic pelvic pain (CPP) is common, affecting up to 26.6% of women (14), yet it remains difficult to treat.

• #31 EAU Guidelines on Chronic Pelvic Pain – Uroweb

  https://uroweb.org/guidelines/chronic-pelvic-pain/chapter/epidemiology-aetiology-and-pathophysiology

  Across the world chronic pain is prevalent, seriously affecting the quality of peoples social, family, and working lives, with differences between countries attributable to multiple causes, including study methodology. A UK study found a prevalence of chronic pelvic pain of 14.8% in women aged 25 years. […] Assessing QoL in pelvic pain patients is challenging due to the complex pathology, the multi-faceted nature of the complaints and the overlap between the different pelvic pelvic pain syndromes. […] Pelvic pain syndromes have an impact in terms of QoL, depression, anxiety, impaired emotional functioning, insomnia and fatigue. […] Chronic pain is, in many countries, the leading cause of years lost to disability, although these figures are dominated by musculoskeletal pain and headache.

• #32 The burden of Chronic Pelvic Pain (CPP): Costs and quality of life of women and men with CPP treated in outpatient referral centers | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0269828

  A 2021 systematic review of women with CPP calculated the direct yearly cost per woman to be between $16,970 to $20,898, this includes healthcare, prescription, and indirect costs (lost wages and reduced productivity). […] For men with CPP, a Northwestern University outpatient urology clinic calculated annual direct costs (via Medicare rates and non-Medicare reimbursements) and lost wages due to absenteeism. […] There is a strong psychosocial impact as CPP patients are affected by anxiety and depression at strikingly higher rates than the general population. […] CPP represents a significant individual and societal burden and although researchers discuss the substantial psychosocial and economic impact, a precise figure is difficult to determine due to the lack of multidisciplinary studies and limited understanding/consensus regarding CPP among researchers and health providers. […] In conclusion, Chronic Pelvic Pain was found to have a large cost burden of $29,951 for in-network services which includes treatments, diagnostics, and surgeries.

• #33 Women’s Health and Perinatology | UiT

  https://uit.no/research/womenshealthperinatology/project?pid=826830&p_document_id=808988

  Chronic pelvic pain is defined as chronic or persistent pain perceived in structures related to the pelvis of either men or women. It is often associated with negative cognitive, behavioural, sexual and emotional consequences as well as with symptoms suggestive of lower urinary tract (LUT), sexual, bowel, pelvic floor or gynaecological dysfunction. […] Chronic pelvic pain (CPP) affects men and women of all ages, and prevalence studies are scarce. Chronic pain disproportionately affects women with low income and education and is thus a major driver of gender inequality and socio-economic disparity in health. The global burden of chronic disease is increasing, and gynaecological conditions rank second among causes of years lived with disability (YLD) for women, accounting for 6.17% of YLD worldwide. Pain related to the pelvic area is associated with shame, is poorly understood and studied, validated screening tools and standardized diagnostic procedures are lacking, and management options are limited. High-quality health care can hardly be delivered if the patient is not diagnosed. CPP frequently has profound impact on womens sex life, desire to have a family, work participation, and quality of life. However, the knowledge gap on CPP regarding prevalence, diagnostics, disease- and societal burden and impact for the patient is huge. […] Our research will contribute to increased knowledge on the condition Chronic pelvic pain, and contribute to development of clinically validated screening tools which can aid clinicians in primary and specialized care institutions.

• #34 Chronic Pelvic Pain | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/26872

  Chronic pelvic pain is a persistent, disabling, or cyclic intermittent pain within the pelvis, most commonly affecting women. In the United States, 1 in 7 women are affected by this condition. Chronic pelvic pain affects approximately 4% to 16% of women. The prevalence of chronic pelvic pain is similar to that of migraine headaches, asthma, and chronic back pain. Chronic pelvic pain primarily affects women, but it accounts for 2% to 16% of cases in men. The overall prevalence of chronic pelvic pain among women ranges from about 4% to 16%. Despite this, only 33% of affected women seek medical care. […] Around 35% of patients with chronic pelvic pain have comorbid IBS. An estimated 61% of women with bladder pain syndrome have comorbid chronic pelvic pain, and nearly 50% of women with endometriosis report chronic pelvic pain. Gynecological comorbidities are present in approximately 20% of patients with chronic pain. Among patients with chronic pelvic pain who undergo elective surgery, 20% to 80% are found to have endometriosis. Conversely, approximately 70% of individuals with a prior diagnosis of endometriosis go on to develop chronic pelvic pain.

• #35

  https://www.who.int/news-room/fact-sheets/detail/endometriosis

  Endometriosis affects roughly 10% (190 million) of reproductive age women and girls globally. […] It is a chronic disease associated with severe, life-impacting pain during periods, sexual intercourse, bowel movements and/or urination, chronic pelvic pain, abdominal bloating, nausea, fatigue, and sometimes depression, anxiety, and infertility. […] Endometriosis often causes severe pain in the pelvis, especially during menstrual periods. […] Some people also experience chronic pelvic pain. […] A careful history of menstrual symptoms and chronic pelvic pain provides the basis for suspecting endometriosis. […] In many countries, the general public and most front-line healthcare providers are not aware that distressing and life-altering pelvic pain is not normal, leading to a normalization and stigmatization of symptoms and significant diagnostic delay.

• #36

  https://www.who.int/news-room/fact-sheets/detail/endometriosis

  Due to diagnostic delays, prompt access to available treatment methods, including non-steroidal analgesics (painkillers), oral contraceptives and progestin-based contraceptives is often not achieved. […] WHO recognizes the importance of advocating for increased awareness, policies and services for endometriosis, and collaborates with civil society and endometriosis patient support groups in this regard.

• #37 Endometriosis: Epidemiology, Classification, Pathogenesis, Treatment and Genetics (Review of Literature)

  https://www.mdpi.com/1422-0067/22/19/10554

  The presence of lateral parametrial endometriosis (LPE) can be considered a reflection of a more severe disease, ureteral stenosis and dilatation, and voiding dysfunctions, mainly because of the involvement of the inferior hypogastric plexus. […] The average age of diagnosis of adenomyosis is between 40 and 50 years of age. However, this disease can occur in young women as well as after menopause. The pathogenesis of adenomyosis remains a mystery. […] The formation of new vessels is a necessary condition for the development of the ectopic endometrium, especially in the peritoneal microenvironment. Neo-angiogenesis is accompanied by the formation of nerves, which may explain the pain in patients. […] Endometriosis has a significant negative impact on aspects of social life, family, and sexual, educational and professional life. Pain and the associated dysfunction of the body worsen the quality of life and reduce professional productivity. In cases where there is no clear cause or medication, the disease can be chronic and recurrent. Due to its impact on sexuality and fertility, it can have a negative impact on partner relationships.

• #38 Epidemiology of chronic pelvic pain

  http://abdel-gadir.com/epidemiology_18.html

  Epidemiology of Chronic Pelvic Pain […] No age group is immune against chronic pelvic pain. With an annual prevalence rate of 38/1000, it is as common as asthma, migraine and lower backache. However, the monthly prevalence rates increased with age from 18.1/1000 in 15-20 years olds to 27.6/1000 in women older than 60 years. The exact prevalence is different in different societies but a figure of 20% is a reasonable average across different age groups. It makes 10% of all gynaecological visits, 40% of all laparoscopies and 10-20% of hysterectomies are usually done for pelvic pain. As well gastroenterologists, urologists, colorectal surgeons and back pain specialists spend considerable time in their respective practices dealing with patients presenting with recurrent episodes of pain. […] Patients with psychological problems are more prone to develop chronic pelvic pain. It is worth noting that history of sexual or physical abuse has been reported in 40-50% of the cases. However, the author of this book dealt with thousands of patients from different communities, who presented with chronic pelvic pain, yet can not confirm that sexual abuse was a regular point in the previous or presentation history. Other reported factors predisposing to chronic pelvic pain included personality, marital and childhood disorders as well as depression and anxiety state. Unfortunately, dealing with these patients in real life is far from ideal. About 60% of them were not referred for specialist care, and 28% never received a diagnosis, 3-4 years after their first consultation.

• #39 Definition and epidemiology of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) | Publisso

  https://series.publisso.de/en/publisso_gold/publishing/books/overview/52/103

  Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a complex of symptoms including urological pain, with or without voiding symptoms. The prevalence is relatively similar across continents raising the possibility that the cause is not dependent on environment. […] A recent review for the International Consultation on Urologic Disease (ICUD) sponsored by the Societ Internationale d’Urologie indicated that prevalence of prostatitis-like symptoms ranged from 2.2% to 16%, with a median prevalence rate approximating 7.1% for chronic prostatitis/chronic pelvic pain syndrome. The mean prevalence in studies according to continent of origin ranged from 6.9% in North America to 12.2% in Africa, with Europe at 8.6%, 7.5% in Asia, and 7.6% in Australia. […] The NIH (U.S.) sponsored Multidisciplinary Approach to Pelvic Pain (MAPP) study has provided insights in to other aspects of the epidemiology of men with chronic pelvic pain who can be classified as CP/CPPS. Of 191 men enrolled in the first MAPP study, 75% were found to have either pain urgency, i.e. urgency to urinate due to pain pressure or discomfort and not due to fear of leaking, or pain that was made worse with bladder filling. […] The phenotype of patients meeting the criteria for CPPS is variable and can include several different types of symptoms. This has been well outlined by Shoskes and colleagues in the UPOINT classification.

• #40 SciELO Brazil – High prevalence of chronic pelvic pain in women in Ribeirão Preto, Brazil and direct association with abdominal surgery High prevalence of chronic pelvic pain in women in Ribeirão Preto, Brazil and direct association with abdominal surger

  https://www.scielo.br/j/clin/a/Z4JKVSSMWmHMVWYvyxRbm7G/

  Chronic pelvic pain is a disease that directly affects the social and professional lives of women. […] To estimate the prevalence of this clinical condition and to identify independent factors associated with it in women living in Ribeiro Preto, Brazil. […] The disease was found in 11.5% (147/1,278) of the sample. The independent predictors were dyspareunia, previous abdominal surgery, depression, dysmenorrhea, anxiety, current sexual activity, low back pain, constipation, urinary symptoms, and low educational level. […] The prevalence of chronic pelvic pain in Ribeiro Preto is high and is associated with conditions that can usually be prevented, controlled, or resolved by improvement of public health policies and public education. […] We identified the following as factors independently associated with chronic pelvic pain: dyspareunia, previous abdominal surgery, depression, dysmenorrhea, anxiety, current sexual activity, low back pain, constipation, urinary symptoms, and low educational level. […] We conclude that the prevalence of CPP in women from Ribeirao Preto is very high, even though only 4% sufferers are aware of their diagnosis. This clinical condition is related to several independent predictors.

• #41 The Underestimated Prevalence of Neglected Chronic Pelvic Pain in Women, a Nationwide Cross-Sectional Study in France

  https://www.mdpi.com/2077-0383/10/11/2481

  Dysmenorrhoea, dyspareunia, and non-menstrual chronic pelvic pain (NMCPP) are symptoms that are probably underreported and neglected. This study aimed to assess the prevalence and overlapping relations between these symptoms among a general population of French women of reproductive age. A cross-sectional study among the nationwide CONSTANCES cohort study recruiting a representative sample of women within different French areas was constructed. Women aged 18–49 years (n = 21,287) who reported periods in the previous three months and experienced intercourse at least once were asked about prevalence of three types of chronic pelvic pain: mild, moderate and severe dysmenorrhea; dyspareunia assessed according to its frequency; NMCPP from a binary question. Between the start of 2012 through the end of 2017, 21,287 women were enrolled, 39.8% of them (95% confidence interval (CI), 39.2–40.5) reported moderate to severe dysmenorrhea; 20.3% (95% CI, 18.7–21.9) of the youngest group (18–24 years) reported severe dysmenorrhea. Dyspareunia was reported to happen often or always by 7.9% (95% CI, 7.5–8.2) and peaked among the youngest women at 12.8% (95% CI, 11.5–14.1). NMCPP was reported by 17.0% (95% CI, 16.5–17.5). Moreover, 7.5% (95% CI, 6.4–8.6) of the women reported two or more types of severe or frequent pain. More attention should be paid to this substantial proportion (7.5%) of French women of reproductive age who experience multiple, severe and frequent pelvic pain symptoms.

• #42 Prevalence of chronic pelvic pain and associated factors among indigenous women of reproductive age in Ecuador | BMC Women’s Health | Full Text

  https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-024-03189-7

  Chronic pelvic pain is a common disease that affects approximately 4% of women of reproductive age in developed countries. This number is estimated to be higher in developing countries, with a significant negative personal and socioeconomic impact on women. The prevalence of primary dysmenorrhea, non-cyclic pelvic pain, and dyspareunia was, respectively, 26.6%, 8.9%, and 3.9%. All forms of chronic pain were independently associated with each other. The prevalence of chronic pelvic pain was 33.0%. […] The prevalence of primary dysmenorrhea identified falls within the range reported worldwide, but interestingly, it is nearly double the rate we previously identified in the non-indigenous population living in an urban area in the capital of Ecuador. […] The results of this study revealed that within this population, the prevalence of chronic pelvic pain is high, with primary dysmenorrhea being the predominant subtype. More than a quarter of women, up to two years after menarche, experienced primary dysmenorrhea, approximately 10% reported non-cyclical pelvic pain, and almost 4% suffered from dyspareunia.

• #43 Prevalence of chronic pelvic pain and associated factors among indigenous women of reproductive age in Ecuador | BMC Women’s Health | Full Text

  https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-024-03189-7

  The prevalence of non-cyclical pelvic pain was similar to that observed in Latin American countries such as Brazil, where its close to 10%. […] The observed prevalence of dyspareunia in this population was significantly lower than that previously reported in the urban population of Ecuador. The findings concerning urinary discomfort contrast with those related to intrauterine infections, which exhibit a notably low prevalence. […] The prevalence of chronic pelvic pain overall was high, 33.0%. Primary dysmenorrhea and non-cyclic chronic pelvic pain in Kichwa women from Otavalo was notably high, while the frequency of reported dyspareunia was comparatively low, at 26.6%, 8.9%, and 3.9% respectively.

• #44 WHO systematic review of prevalence of chronic pelvic pain: a neglected reproductive health morbidity | BMC Public Health | Full Text

  https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-6-177

  The variation in rates of CPP worldwide was explained by variable study quality. […] The number of population-based studies yielding estimates of burden of CPP from less developed countries was low. […] High quality literature comprising representative samples revealed a high burden of disease for all types of pelvic pain, however, there remained heterogeneity in these subgroup of studies. […] The information on the rates of dysmenorrhoea, dyspareunia have implication for provision of services to policymakers in terms of provision of improved access for these women to health care resources as well as the development of appropriate treatment protocols. […] There were few valid population based estimates of disease burden due to CPP from less developed countries.

• #45 Prevalence of chronic pelvic pain among women: an updated review – PubMed

  https://pubmed.ncbi.nlm.nih.gov/24658485/

  Chronic pelvic pain (CPP), defined as a noncyclical pain lasting for more than 6 months can lead to lower physical performance and quality of life in women. CPP is a worldwide problem affecting women of all ages. […] Based on these articles, prevalence in general ranged between 5.7% and 26.6%. There were many countries and regions without basic data in the field of CPP. This review shows the paucity of studies, especially multidisciplinary researches with multifactorial views on CPP. Multidisciplinary studies would provide more reliable data for estimating the prevalence of CPP and its psycho-socioeconomic burden, as well as finding its etiologies and characteristics.

• #46 Chronic pelvic pain: epidemiology and risk factors – Eesti Arst – Eesti Arstide Liidu ajakiri

  https://eestiarst.ee/en/chronic-pelvic-pain-epidemiology-and-risk-factors/

  Chronic pelvic pain (CPP) is a common condition in women that is hard to diagnose. The epidemiology of CPP is very difficult to investigate because of: 1) lack of consensus regarding its clinical definition across studies; 2) its multi-causal origin; and 3) study design complications. Using the most common definition of CPP (lower abdominal pain of at least 6 month`s duration, excluding pain solely related to pregnancy, menstruation, or intercourse), the prevalence of CPP among women of reproductive age in general population is estimated to be as high as 25%. […] Investigation of the aetiology of CPP through assessment of risk factors remains highly complicated because of the complexity of the condition. Half the women with chronic pelvic pain also have either genitourinary or irritable bowel syndrome, or both. Prevalence of dysmenorrhea and dyspareunia is higher among women with CPP than among women without chronic pelvic pain. […] Irritable bowel syndrome and stress were the most common diagnoses received by patients with chronic pelvic pain, but in 50% the diagnosis was never made.

• #47 The Underestimated Prevalence of Neglected Chronic Pelvic Pain in Women, a Nationwide Cross-Sectional Study in France

  https://www.mdpi.com/2077-0383/10/11/2481

  Chronic pelvic pain symptoms among women of reproductive age are one of their most frequent reason for seeking health care. These symptoms generally include at least one of three types of pain: dysmenorrhea, dyspareunia, and non-menstrual chronic pelvic pain (NMCPP, not related to period or intercourse). Their prevalence among the general population are currently unknown, because of various methodological issues (small samples or from other studies not designed for this purpose) and bias when collecting data (estimates by telephone interviews or postal surveys). Moreover, women barely seek medical care for menstrual symptoms because they believe them to be part of the “female condition” especially among young people whereas pain acceptance among dysmenorrhea appears to be associated with better physical and mental quality of life. Thus, this situation may also explain the failure to complain about dyspareunia or NMCPP among women. This observation may reflect an attitude in the general population that prevents women from seeking and doctors from providing the appropriate clinical care. It may also reveal that chronic pelvic pain is an underestimated and neglected symptom that women have to deal with.

• #48 The burden of Chronic Pelvic Pain (CPP): Costs and quality of life of women and men with CPP treated in outpatient referral centers | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0269828

  Chronic Pelvic Pain (CPP) is a complex, multifaceted condition that affects both women and men. There is limited literature on the cost utilization the healthcare system and CPP patients incur. The purpose of this analysis is to characterize the overall healthcare utilization, cost burden, and quality-of-life restrictions experienced by CPP patients using data from an outpatient pelvic rehabilitation practice. […] About 14% percent of women experience CPP during their life. Urological chronic pelvic pain syndrome (UCPPS) affects 2%-16% of men worldwide. […] Direct costs associated with CPP, related organ system dysfunctions, and the indirect costs of productivity loss, absenteeism, and missed wages are significant. […] A study analyzing 5,879 women diagnosed with Endometriosis discovered a positive correlation between symptom severity and hours of employment productivity lost: women with mild severity reported a weekly loss of 1.9 hours compared to 15.8 hours lost for severe symptoms.

• #49 MAPP Research Network – Multi-site cohort study of males and females with urologic chronic pelvic pain syndrome (UCPPS)

  https://www.mappnetwork.org/

  In 2008 the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health (NIH) launched the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network. This study represented a novel, highly collaborative and multidisciplinary research effort designed to better understand the underlying pathophysiology and patient phenotypes (i.e., observable biological and clinical characteristics) for the two most prominent chronic urologic pain conditions, Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS) in women and men and Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) in men. […] The MAPP DataView Dashboard permits exploration and visualization of clinical research data obtained from the MAPP I EPS and MAPP II SPS cohort study participants with UCPPS, and selected control participants.

• #50 The Prevalence and Overlap of Interstitial Cystitis/Bladder Pain Syndrome and Chronic Prostatitis/Chronic Pelvic Pain Syndrome in Men: Results of the RAND Interstitial Cystitis Epidemiology Male Study | RAND

  https://www.rand.org/pubs/external_publications/EP51302.html

  PURPOSE: As part of the RICE (RAND Interstitial Cystitis Epidemiology) study, we developed validated case definitions to identify interstitial cystitis/bladder pain syndrome in women and chronic prostatitis/chronic pelvic pain syndrome in men. […] RESULTS: The interstitial cystitis/bladder pain syndrome weighted prevalence estimates for the high sensitivity and high specificity definitions were 4.2% (3.15.3) and 1.9% (1.12.7), respectively. The chronic prostatitis/chronic pelvic pain syndrome weighted prevalence estimate was 1.8% (0.92.7). These values equate to 1,986,972 (95% CI 966,0422,996,924) men with chronic prostatitis/chronic pelvic pain syndrome and 2,107,727 (95% CI 1,240,4852,974,969) men with the high specificity definition of interstitial cystitis/bladder pain syndrome in the United States. The overlap between men who met the high specificity interstitial cystitis/bladder pain syndrome case definition or the chronic prostatitis/chronic pelvic pain syndrome case definition was 17%.

• #51 Definition and epidemiology of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) | Publisso

  https://series.publisso.de/en/publisso_gold/publishing/books/overview/52/103

  Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a complex of symptoms including urological pain, with or without voiding symptoms. The prevalence is relatively similar across continents raising the possibility that the cause is not dependent on environment. […] A recent review for the International Consultation on Urologic Disease (ICUD) sponsored by the Societ Internationale d’Urologie indicated that prevalence of prostatitis-like symptoms ranged from 2.2% to 16%, with a median prevalence rate approximating 7.1% for chronic prostatitis/chronic pelvic pain syndrome. The mean prevalence in studies according to continent of origin ranged from 6.9% in North America to 12.2% in Africa, with Europe at 8.6%, 7.5% in Asia, and 7.6% in Australia. […] The NIH (U.S.) sponsored Multidisciplinary Approach to Pelvic Pain (MAPP) study has provided insights in to other aspects of the epidemiology of men with chronic pelvic pain who can be classified as CP/CPPS. Of 191 men enrolled in the first MAPP study, 75% were found to have either pain urgency, i.e. urgency to urinate due to pain pressure or discomfort and not due to fear of leaking, or pain that was made worse with bladder filling. […] The phenotype of patients meeting the criteria for CPPS is variable and can include several different types of symptoms. This has been well outlined by Shoskes and colleagues in the UPOINT classification.

• #52 Chronic Pelvic Pain and Chronic Pelvic Pain Syndrome: Classification and Epidemiology | SpringerLink

  https://link.springer.com/chapter/10.1007/978-3-030-56387-5_4

  Chronic pelvic pain (CPP) is less well defined than bladder, urethral or perineal pain, and is less clearly related to the micturition cycle or to bowel function and is not localized to any single pelvic organ. […] There are insufficient data available on the epidemiology of CPP to design a complete and correct incidence. The prevalence for women in reproductive ages is between 14 and 24% and about 14% of women experience CPP at least for one time during their life. […] The prevalence of bladder pain syndrome has great variability because of its controversial clinical diagnosis and the method of screening, ranging from 0.06% to 30%. Population-based prevalence of prostatitis symptoms ranges from 1% to 14.2%.

• #53 Pelvic Congestion Syndrome: Etiology, Symptoms, and Epidemiology of a Chronic Pelvic Pain Disorder – Acta Pharma Reports | Journal |

  https://pharma.researchfloor.org/pelvic-congestion-syndrome-etiology-symptoms-and-epidemiology-of-a-chronic-pelvic-pain-disorder/

  Pelvic Congestion Syndrome (PCS) is a chronic condition primarily affecting premenopausal, multiparous women, characterized by persistent pelvic pain and discomfort. […] Epidemiological data indicate that around 30% of women presenting with chronic pelvic pain may have PCS, making it a significant contributor to chronic pelvic discomfort. […] The study of epidemiology Pelvic congestion syndrome primarily affects premenopausal multiparous women. […] Nearly 30% of patients with presenting complaints of chronic pelvic pain have the illness. […] Approximately 2.1% to 24% of women in the 1850 age range have pelvic congestion syndrome. […] Approximately 10% to 20% of gynecologic visits are related to chronic pelvic pain.

• #54 Pelvic Congestion Syndrome: Etiology, Symptoms, and Epidemiology of a Chronic Pelvic Pain Disorder – Acta Pharma Reports | Journal |

  https://pharma.researchfloor.org/pelvic-congestion-syndrome-etiology-symptoms-and-epidemiology-of-a-chronic-pelvic-pain-disorder/

  Pelvic Congestion Syndrome (PCS) is a chronic condition primarily affecting premenopausal, multiparous women, characterized by persistent pelvic pain and discomfort. […] Epidemiological data indicate that around 30% of women presenting with chronic pelvic pain may have PCS, making it a significant contributor to chronic pelvic discomfort. […] The study of epidemiology Pelvic congestion syndrome primarily affects premenopausal multiparous women. […] Nearly 30% of patients with presenting complaints of chronic pelvic pain have the illness. […] Approximately 2.1% to 24% of women in the 1850 age range have pelvic congestion syndrome. […] Approximately 10% to 20% of gynecologic visits are related to chronic pelvic pain.

• #55 Chronic orchialgia: epidemiology, diagnosis and evaluation – Sigalos – Translational Andrology and Urology

  https://tau.amegroups.org/article/view/14934/html

  Chronic pelvic pain syndromes more generally have been better characterized and studied in women than in men. Chronic pelvic pain affects approximately 15% of women 18-50 years old. In contrast, a recent study of 900 Swedish men estimated that chronic pelvic pain only affects 3-5% of men 40-69 years old. The differential diagnosis of chronic pelvic pain includes scrotal and testicular pain. Zermann observed that 38.8% of cases of chronic pelvic pain in men localize to the scrotum. A Swedish study that surveyed how urologists treat chronic scrotal pain estimated that 2.5% of visits are for chronic scrotal pain, given that urologists on average self-reported 6.5 new patient visits with a primary diagnosis of chronic scrotal pain monthly. A more recent study observed chronic scrotal pain in 4.8% (113/2,375) of men who presented to an outpatient urologist.

• #56 Chronic orchialgia: epidemiology, diagnosis and evaluation – Sigalos – Translational Andrology and Urology

  https://tau.amegroups.org/article/view/14934/html

  Chronic pelvic pain syndromes more generally have been better characterized and studied in women than in men. Chronic pelvic pain affects approximately 15% of women 18-50 years old. In contrast, a recent study of 900 Swedish men estimated that chronic pelvic pain only affects 3-5% of men 40-69 years old. The differential diagnosis of chronic pelvic pain includes scrotal and testicular pain. Zermann observed that 38.8% of cases of chronic pelvic pain in men localize to the scrotum. A Swedish study that surveyed how urologists treat chronic scrotal pain estimated that 2.5% of visits are for chronic scrotal pain, given that urologists on average self-reported 6.5 new patient visits with a primary diagnosis of chronic scrotal pain monthly. A more recent study observed chronic scrotal pain in 4.8% (113/2,375) of men who presented to an outpatient urologist.

• #57 Chronic orchialgia: epidemiology, diagnosis and evaluation – Sigalos – Translational Andrology and Urology

  https://tau.amegroups.org/article/view/14934/html

  Chronic orchialgia can therefore be classified as part of the spectrum of chronic pelvic pain syndromes in men, and specific questions about sexual health and abuse are important given that men with chronic pelvic pain have an increased risk [odds ratio (OR) of 1.7-3.3] of having experienced psychological, physical, and sexual abuse.

• #58 Chronic pelvic pain: epidemiology and risk factors – Eesti Arst – Eesti Arstide Liidu ajakiri

  https://eestiarst.ee/en/chronic-pelvic-pain-epidemiology-and-risk-factors/

  Chronic pelvic pain (CPP) is a common condition in women that is hard to diagnose. The epidemiology of CPP is very difficult to investigate because of: 1) lack of consensus regarding its clinical definition across studies; 2) its multi-causal origin; and 3) study design complications. Using the most common definition of CPP (lower abdominal pain of at least 6 month`s duration, excluding pain solely related to pregnancy, menstruation, or intercourse), the prevalence of CPP among women of reproductive age in general population is estimated to be as high as 25%. […] Investigation of the aetiology of CPP through assessment of risk factors remains highly complicated because of the complexity of the condition. Half the women with chronic pelvic pain also have either genitourinary or irritable bowel syndrome, or both. Prevalence of dysmenorrhea and dyspareunia is higher among women with CPP than among women without chronic pelvic pain. […] Irritable bowel syndrome and stress were the most common diagnoses received by patients with chronic pelvic pain, but in 50% the diagnosis was never made.

• #59

  http://www.diva-portal.org/smash/record.jsf?pid=diva2:770659

  Results: From 140 studies, only 7 studies were about CPP prevalence. Their study design consisted of 3 cross sectional studies, one population based mailing questionnaire study, one survey study (computer assisted telephone interview), one data analysis by questionnaire, and one prospective community based study. […] Limitations: Paucity of population based studies in addition to probability of existence of studies at the local level with limited access to worldwide databases, lack of consensus about definition of CPP among researchers and therapists, and non-inclusion of CPP related key words in databases such as PubMed. […] Conclusion: Based on these articles, prevalence in general ranged between 5.7% and 26.6%. There were many countries and regions without basic data in the field of CPP. This review shows the paucity of studies, especially multidisciplinary researches with multifactorial views on CPP. Multidisciplinary studies would provide more reliable data for estimating the prevalence of CPP and its psycho-socioeconomic burden, as well as finding its etiologies and characteristics. This would be the first step towards better treatment and care for women with CPP.

• #60 WHO systematic review of prevalence of chronic pelvic pain: a neglected reproductive health morbidity | BMC Public Health | Full Text

  https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-6-177

  Health care planning for chronic pelvic pain (CPP), an important cause of morbidity amongst women is hampered due to lack of clear collated summaries of its basic epidemiological data. […] We systematically reviewed worldwide literature on the prevalence of different types of CPP to assess the geographical distribution of data, and to explore sources of variation in its estimates. […] Valid information about the true extent of CPP is an essential consideration in resource allocation and health care planning. […] The epidemiological features of CPP have been generously reported in the worldwide literature. […] A systematic literature review was performed to ascertain: the prevalence rates of CPP according to the type of pain; its geographical distribution; its variation within subgroups defined by age and development status of the country of origin; and the effect of study quality and representativeness on the rates.

• #61 Prevalence of chronic pelvic pain among women: an updated review – PubMed

  https://pubmed.ncbi.nlm.nih.gov/24658485/

  Chronic pelvic pain (CPP), defined as a noncyclical pain lasting for more than 6 months can lead to lower physical performance and quality of life in women. CPP is a worldwide problem affecting women of all ages. […] Based on these articles, prevalence in general ranged between 5.7% and 26.6%. There were many countries and regions without basic data in the field of CPP. This review shows the paucity of studies, especially multidisciplinary researches with multifactorial views on CPP. Multidisciplinary studies would provide more reliable data for estimating the prevalence of CPP and its psycho-socioeconomic burden, as well as finding its etiologies and characteristics.

• #62 Epidemiology of chronic pelvic pain

  http://abdel-gadir.com/epidemiology_18.html

  To combat this apathy, dedicated multidisciplinary teams are needed for the proper diagnosis, management and follow up of patients with this complex problem. To deal with these patients, the teams involved should adopt the following general principles: Always think of different causes, rather than one cause for chronic pelvic pain. Identifying and treating one pathology is unlikely to be successful. Always try to identify all pain generators and deal with them in a total pain management plan. […] The ultimate objectives in dealing with patients with chronic pelvic pain are: Provide adequate pain relief and reduce the frequency of pain episodes. Identify the possible sources of pain and deal with them either medically or surgically. Improve the quality of life to allow the patient to lead a normal or as near normal life as possible and to function normally in her family and society. Deal with any predisposing psychological factors or other current concerns which are worrying the patient.

• #63 Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) | IREACH | Washington State University

  https://ireach.wsu.edu/projects/multidisciplinary-approach-to-the-study-of-chronic-pelvic-pain/

  The Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network was established by the National Institute of Diabetes and Digestive and Kidney Diseases to investigate urologic chronic pelvic pain syndrome (UCPPS), which encompasses two highly prevalent chronic urologic pain disordersinterstitial cystitis/ bladder pain syndrome (IC/BPS) in men and women, and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) in men. […] This poorly understood and characterized disorder has a mostly empirical and unsatisfactory treatment. […] The MAPP Networks research was designed to study the etiology and treated natural history of UCPPS, to inform better treatments and management of symptoms through improved designs of clinical trials, and to identify clinical factors and research measurements to define clinically relevant sub-groups of these patients.

• #64 JU INSIGHT Urological Chronic Pelvic Pain Syndrome Symptom Flares, Illness Impact, and Health Care Seeking – American Urological Association

  https://auanews.net/issues/articles/2023/april-extra-2023/ju-insight-urological-chronic-pelvic-pain-syndrome-symptom-flares-illness-impact-and-health-care-seeking

  Sutcliffe S, Newcomb C, Bradley CS et al, for the MAPP Research Network. Associations between urological chronic pelvic pain syndrome symptom flares, illness impact, and health care seeking activity: findings from the Multidisciplinary Approach to the Study of Chronic Pelvic Pain Symptom Patterns study. J Urol. 2023;209(4):719-725. […] Urological chronic pelvic pain syndrome (UCPPS) symptom exacerbations or “flares” are often painful and debilitating, yet little is known about how to prevent and/or treat them. […] In the Multidisciplinary Approach to the Study of Chronic Pelvic Pain Network Symptom Patterns Study (N=613), we found that participants who experienced ≥2 flares/wk had significantly worse condition-specific illness impact and greater health care seeking activity than those without flares, even after comparing participants with similar typical nonflare and overall pelvic pain levels.

• #65 JU INSIGHT Urological Chronic Pelvic Pain Syndrome Symptom Flares, Illness Impact, and Health Care Seeking – American Urological Association

  https://auanews.net/issues/articles/2023/april-extra-2023/ju-insight-urological-chronic-pelvic-pain-syndrome-symptom-flares-illness-impact-and-health-care-seeking

  Sutcliffe S, Newcomb C, Bradley CS et al, for the MAPP Research Network. Associations between urological chronic pelvic pain syndrome symptom flares, illness impact, and health care seeking activity: findings from the Multidisciplinary Approach to the Study of Chronic Pelvic Pain Symptom Patterns study. J Urol. 2023;209(4):719-725. […] Urological chronic pelvic pain syndrome (UCPPS) symptom exacerbations or “flares” are often painful and debilitating, yet little is known about how to prevent and/or treat them. […] In the Multidisciplinary Approach to the Study of Chronic Pelvic Pain Network Symptom Patterns Study (N=613), we found that participants who experienced ≥2 flares/wk had significantly worse condition-specific illness impact and greater health care seeking activity than those without flares, even after comparing participants with similar typical nonflare and overall pelvic pain levels.

• #66 JU INSIGHT Urological Chronic Pelvic Pain Syndrome Symptom Flares, Illness Impact, and Health Care Seeking – American Urological Association

  https://auanews.net/issues/articles/2023/april-extra-2023/ju-insight-urological-chronic-pelvic-pain-syndrome-symptom-flares-illness-impact-and-health-care-seeking

  Our findings suggest that patients may derive benefit from preventive and therapeutic strategies that reduce flare frequency even if they do not reduce “typical” pelvic pain levels. Therefore, we recommend including flare frequency as an additional outcome measure in UCPPS research to support the development of new flare strategies.

• #67 Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) | IREACH | Washington State University

  https://ireach.wsu.edu/projects/multidisciplinary-approach-to-the-study-of-chronic-pelvic-pain/

  During the MAPP Networks five-year project period (MAPP I), the primary clinical research effort was a prospective cohort study, the Trans-MAPP Epidemiology/Phenotyping Study. […] The second phase of the MAPP Network, the Trans-MAPP Symptom Patterns Study, is now coming to an end and was designed to conduct a prospective, observational study of men and women with UCPPS, referred to as the Trans-MAPP Symptom Patterns Study.

• #68 Noncyclic Chronic Pelvic Pain Therapies for Women: Comparative Effectiveness | Effective Health Care (EHC) Program

  https://effectivehealthcare.ahrq.gov/products/pelvic-pain/research

  Improved characterization of the targeted condition, intervention, and population in CPP research is necessary to inform treatment choices for this commonly reported entity. A uniform definition of CPP and standardized evaluation of participants are lacking across the literature. Study populations likely vary widely, and studies may be reporting effects from treating symptoms rather than a diagnosed condition. Thus our understanding of potential treatment effects is diluted. Similarly, understanding comorbidity prevalence with CPP is difficult, as conditions may be considered part of the differential diagnosis or a concomitant condition. Among studies addressing treatment effects, little evidence demonstrates the effectiveness of surgical approaches. Studies of nonsurgical approaches typically addressed hormonal management of endometriosis-related CPP and were not placebo controlled, thus limiting our ability to understand whether hormonal therapies would be beneficial for women with CPP without endometriosis and whether pain relief is due simply to the placebo effect. Some studies reported benefits of other nonsurgical approaches, but nonhormonal and nonpharmacologic management remain understudied.

• #69 WHO systematic review of prevalence of chronic pelvic pain: a neglected reproductive health morbidity | BMC Public Health | Full Text

  https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-6-177

  The variation in rates of CPP worldwide was explained by variable study quality. […] The number of population-based studies yielding estimates of burden of CPP from less developed countries was low. […] High quality literature comprising representative samples revealed a high burden of disease for all types of pelvic pain, however, there remained heterogeneity in these subgroup of studies. […] The information on the rates of dysmenorrhoea, dyspareunia have implication for provision of services to policymakers in terms of provision of improved access for these women to health care resources as well as the development of appropriate treatment protocols. […] There were few valid population based estimates of disease burden due to CPP from less developed countries.

• #70

  https://www.who.int/news-room/fact-sheets/detail/endometriosis

  Due to diagnostic delays, prompt access to available treatment methods, including non-steroidal analgesics (painkillers), oral contraceptives and progestin-based contraceptives is often not achieved. […] WHO recognizes the importance of advocating for increased awareness, policies and services for endometriosis, and collaborates with civil society and endometriosis patient support groups in this regard.

• #71 Women’s Health and Perinatology | UiT

  https://uit.no/research/womenshealthperinatology/project?pid=826830&p_document_id=808988

  Chronic pelvic pain is defined as chronic or persistent pain perceived in structures related to the pelvis of either men or women. It is often associated with negative cognitive, behavioural, sexual and emotional consequences as well as with symptoms suggestive of lower urinary tract (LUT), sexual, bowel, pelvic floor or gynaecological dysfunction. […] Chronic pelvic pain (CPP) affects men and women of all ages, and prevalence studies are scarce. Chronic pain disproportionately affects women with low income and education and is thus a major driver of gender inequality and socio-economic disparity in health. The global burden of chronic disease is increasing, and gynaecological conditions rank second among causes of years lived with disability (YLD) for women, accounting for 6.17% of YLD worldwide. Pain related to the pelvic area is associated with shame, is poorly understood and studied, validated screening tools and standardized diagnostic procedures are lacking, and management options are limited. High-quality health care can hardly be delivered if the patient is not diagnosed. CPP frequently has profound impact on womens sex life, desire to have a family, work participation, and quality of life. However, the knowledge gap on CPP regarding prevalence, diagnostics, disease- and societal burden and impact for the patient is huge. […] Our research will contribute to increased knowledge on the condition Chronic pelvic pain, and contribute to development of clinically validated screening tools which can aid clinicians in primary and specialized care institutions.

• #72 The Underestimated Prevalence of Neglected Chronic Pelvic Pain in Women, a Nationwide Cross-Sectional Study in France

  https://www.mdpi.com/2077-0383/10/11/2481

  A substantial proportion of French women experience multiple severe or frequent pelvic pain symptoms which are elements that may suggest diseases such as endometriosis: severe dysmenorrhea, frequent dyspareunia, and non-menstrual chronic pelvic pain. These women should be further analyzed to have a better characterization of their symptoms and the consequences on their daily life (impact on sexual life or on work efficiency) as they are probably neglected by medical staff. More attention should be paid to these women of reproductive age because they might be proposed for medical assistance and specific follow-up.

• #73 Noncyclic Chronic Pelvic Pain Therapies for Women: Comparative Effectiveness | Effective Health Care (EHC) Program

  https://effectivehealthcare.ahrq.gov/products/pelvic-pain/research

  Improved characterization of the targeted condition, intervention, and population in CPP research is necessary to inform treatment choices for this commonly reported entity. A uniform definition of CPP and standardized evaluation of participants are lacking across the literature. Study populations likely vary widely, and studies may be reporting effects from treating symptoms rather than a diagnosed condition. Thus our understanding of potential treatment effects is diluted. Similarly, understanding comorbidity prevalence with CPP is difficult, as conditions may be considered part of the differential diagnosis or a concomitant condition. Among studies addressing treatment effects, little evidence demonstrates the effectiveness of surgical approaches. Studies of nonsurgical approaches typically addressed hormonal management of endometriosis-related CPP and were not placebo controlled, thus limiting our ability to understand whether hormonal therapies would be beneficial for women with CPP without endometriosis and whether pain relief is due simply to the placebo effect. Some studies reported benefits of other nonsurgical approaches, but nonhormonal and nonpharmacologic management remain understudied.

• #74

  https://www.who.int/news-room/fact-sheets/detail/endometriosis

  Due to diagnostic delays, prompt access to available treatment methods, including non-steroidal analgesics (painkillers), oral contraceptives and progestin-based contraceptives is often not achieved. […] WHO recognizes the importance of advocating for increased awareness, policies and services for endometriosis, and collaborates with civil society and endometriosis patient support groups in this regard.

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