Materiały źródłowe

• #1 Chronic pelvic pain – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/chronic-pelvic-pain/symptoms-causes/syc-20354368

  Chronic pelvic pain can have more than one cause. It may be a symptom of another disease, or it can be a condition in its own right. […] Chronic pelvic pain is a complex health problem. Sometimes, tests may find that a single disease is the cause. In other cases, the pain may stem from more than one medical condition. For example, you might have endometriosis and interstitial cystitis, both of which play a role in chronic pelvic pain. […] Some causes of chronic pelvic pain include: Endometriosis. This is a disease where tissue that’s like the lining of the uterus grows outside the uterus. It may cause pain or infertility. Muscle and bone problems. Health issues that affect bones, joints and connective tissues can lead to pelvic pain that keeps coming back. These problems include fibromyalgia, tension in pelvic floor muscles, swelling of the pubic joint or a hernia. Nerve injury. Injured or trapped nerves in the pelvis or lower stomach area can lead to ongoing pelvic pain. Nerve problems might happen after surgery in the lower stomach area, such as having a C-section. Or lasting pain could result after injury to a nerve in the pelvis called the pudendal nerve from repetitive activities such as cycling, riding horses or sitting for long periods of time. This condition is called pudendal neuralgia. Chronic pelvic inflammatory disease. This can happen if a long-term infection, often spread through sex, causes scarring that involves the pelvic organs. Ovarian remnant. After surgery to remove one or both ovaries, a small piece of ovary may be left inside by mistake. Later, this leftover tissue may form painful cysts. Fibroids. These growths inside, on or attached to the uterus aren’t cancer. But they may cause pressure or a feeling of heaviness in the lower stomach area or lower back. Rarely, they cause sharp pain. Irritable bowel syndrome. Symptoms linked with irritable bowel syndrome bloating, constipation or diarrhea can be a source of pelvic pain and pressure. Painful bladder syndrome. This also is called interstitial cystitis. It’s linked with pain in the bladder that keeps coming back. It’s also tied to a frequent need to urinate. You may have pelvic pain as your bladder fills. The pain may get better for a while after you empty your bladder. Pelvic congestion syndrome. Enlarged, varicose-type veins around the uterus and ovaries can lead to pelvic pain. Mental health risk factors. Depression, long-term stress, or a history of sexual or physical abuse may raise your risk of chronic pelvic pain. Emotional distress can make pain worse. And long-term pain can fuel distress. These two factors often become a vicious cycle.

• #2 Chronic Pelvic Pain | ACOG

  https://www.acog.org/womens-health/faqs/chronic-pelvic-pain

  Chronic pelvic pain can be caused by a variety of conditions. Some of these conditions may not be related to the reproductive organs but to the urinary tract or bowel. […] Sometimes there is more than one condition that might be the cause of the pain. Sometimes no cause is found. Not finding a cause does not mean that the pain is not real. Experts agree that with pelvic pain, it is not always possible to pinpoint a specific cause. […] Pelvic inflammatory disease (PID) is an infection of the reproductive organs that may cause both acute and chronic pelvic pain. […] Dysmenorrhea (painful periods) is one cause of chronic pelvic pain. […] Endometriosis may be the cause if menstrual pain gets worse over time, lasts beyond the first 1 or 2 days of menstrual flow, or occurs throughout the month or during sex.

• #3 Patient education: Chronic pelvic pain in females (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/chronic-pelvic-pain-in-females-beyond-the-basics

  Chronic pelvic pain is defined as pain that occurs in the pelvic area (below the belly button) and lasts for at least six months. It may or may not be associated with menstrual periods. While chronic pelvic pain can be a symptom caused by one or more different conditions, in many cases, it is a condition related to how the central nervous system processes pain signals (often called „centralized pain”). When this happens, the nervous system overreacts to various triggers, and the person experiences more pain than would normally be expected. […] A variety of gynecologic, gastrointestinal, urologic, musculoskeletal, and body-wide disorders can cause chronic pelvic pain. […] Chronic pelvic pain is thought to have gynecologic causes (originating in the female reproductive tract) in approximately 20 percent of women. Some of the gynecologic causes of pelvic pain include: Endometriosis, Uterine fibroids, Adenomyosis, Pelvic inflammatory disease, Pelvic adhesive disease.

• #4 Chronic Pelvic Pain in Women: Symptoms, Causes, Risk factors and Treatment | MedPark Hospital

  https://www.medparkhospital.com/en-US/disease-and-treatment/chronic-pelvic-pain-in-women

  Chronic pelvic pain in women can result from many conditions, including gynecologic, gastrointestinal, urologic, musculoskeletal, and body-wide disorders. […] 20 % of women with chronic pelvic pain have gynecologic origins, including: […] Endometriosis occurs when uterine lining endometrial-like tissue is present at sites outside of its natural location or extending into the uterine muscles causing the uterus to swell and enlarge, leading to painful menstruation. […] Uterine fibroids (benign growths in the uterus): Almost half of the women have this condition but around 25% experience pelvic pain, heavy menstruation, and infertility. […] Pelvic inflammatory disease (PID) is a female reproductive organ infection that can be a complication of a sexually transmitted disease or abdominal infection. PID can cause chronic pelvic pain and infertility.

• #5 Chronic Pelvic Pain in Women: Symptoms and Causes – Weiss Memorial Hospital

  https://www.weisshospital.com/news/chronic-pelvic-pain-in-women-symptoms-and-causes/

  Ovarian remnant syndrome occurs when small pieces of the ovary are left in the pelvic cavity after surgical removal of the uterus, ovaries, and fallopian tubes. These remnants can lead to inflammation and painful cysts. […] Fibroids are noncancerous uterine growths in the uterus. In some cases, they can cause heavy menstrual bleeding and pelvic pain. […] Irritable bowel syndrome is an intestinal disorder that causes bloating, gas, diarrhea, and constipation. Symptoms associated with irritable bowel syndrome can be a source of pelvic pain and pressure. […] Painful bladder syndrome is characterized by recurring bladder pain and frequent urination. Pelvic pain may occur as your bladder fills, temporarily improving after you empty it. […] Pelvic congestion syndrome occurs when enlarged, varicose-type veins around your uterus and ovaries cause pain in the pelvis.

• #5 Chronic Pelvic Pain in Women: Symptoms and Causes – Weiss Memorial Hospital

  https://www.weisshospital.com/news/chronic-pelvic-pain-in-women-symptoms-and-causes/

  Chronic pelvic pain may be caused by a number of conditions. Many times, it can be attributed to a combination of disorders that lead to pain and discomfort. Sometimes the cause is unknown. Below are some common causes of chronic pelvic pain. […] Endometriosis is a disorder in which tissue that normally lines the uterus grows outside the uterus. Surrounding areas may become inflamed or swollen and lead to scar tissue and lesions. […] Musculoskeletal conditions affecting your bones, joints and connective tissues can lead to recurring pelvic pain. Common musculoskeletal conditions include pelvic floor muscle tension, fibromyalgia, hernia, and pubic joint inflammation. […] Chronic pelvic inflammatory disease occurs when there is an infection in the reproductive organs. This is often caused by sexually transmitted diseases and may lead to scarring of the pelvic organs.

• #6 Chronic Pelvic Pain – StatPearls – NCBI Bookshelf

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

  Chronic pelvic pain is often secondary to comorbid conditions that cause chronic pain. […] A synergistic effect can occur when dysfunction in an organ system leads to issues in another. […] As comorbidities accumulate, the persistence of symptoms promotes central sensitization, further intensifying pain perception. […] Chronic pelvic pain has a significant psychiatric component. […] Anatomical changes resulting from various pathologies may serve as primary contributors to the development of chronic pelvic pain. […] The risk of developing chronic pelvic pain is further elevated in patients who smoke, have underlying mental health conditions, or have experienced two or more episodes of pelvic inflammatory disease. […] Endometriosis is another frequently associated comorbidity, with strong links to both chronic pelvic pain and IBS.

• #6 Chronic Pelvic Pain – StatPearls – NCBI Bookshelf

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

  Chronic pelvic pain is often associated with conditions such as irritable bowel syndrome (IBS), interstitial cystitis, pelvic inflammatory disease, and mood disorders. […] 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. […] In more than half of chronic pelvic pain cases, comorbid conditions such as endometriosis, pelvic adhesions, IBS, or interstitial cystitis are present. […] Although chronic pelvic pain was historically considered a form of reflex dystrophy, this condition is now understood as a chronic pain syndrome involving central sensitization and significant psychological components. […] The pathophysiology of chronic pelvic pain is thought to involve centralized pain mechanisms.

• #7 Patient education: Chronic pelvic pain in females (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/chronic-pelvic-pain-in-females-beyond-the-basics

  Nongynecologic causes of chronic pelvic pain may be related to the digestive system, urinary system, or to irritation in the muscles and nerves in the pelvis. Studies suggest that both irritable bowel syndrome (IBS) and bladder pain syndrome and interstitial cystitis (BPS/IC) are associated with dysregulated pain processing. […] Chronic pelvic pain has multiple possible treatments; these are often used in combination.

• #8 Chronic Pelvic Pain | ACOG

  https://www.acog.org/womens-health/faqs/chronic-pelvic-pain

  Fibroids may cause heavier or more frequent menstrual periods and pain or pressure in the abdomen or lower back. […] Many urinary conditions have been linked to chronic pelvic pain, including kidney stones, repeated urinary tract infections (UTIs), and cancer of the bladder. […] Irritable bowel syndrome (IBS) is one of the most common conditions associated with chronic pelvic pain. […] Lower back pain, disk injuries, and pelvic muscle spasms all may cause chronic pelvic pain. […] There appears to be a link between chronic pelvic pain and sexual or physical abuse. […] Depression also appears to be a complicating factor. But it is rarely the sole cause of chronic pelvic pain. Physical causes should always be considered.

• #9 8 common causes of pelvic pain | Louisville, Ky.Norton Healthcare

  https://nortonhealthcare.com/news/causes-of-pelvic-pain/

  A urinary tract infection (UTI) or interstitial cystitis are common causes of pelvic pain in women. UTIs occur when bacteria enter the urinary tract and cause infection, leading to symptoms such as pelvic pain, frequent urination and a painful or burning sensation during urination. […] Interstitial cystitis is a chronic condition characterized by bladder pain and urinary urgency. The inflammation of the bladder wall in interstitial cystitis can result in pelvic pain that is often described as a constant, dull ache in the lower abdomen and pelvic region. […] It is important to work with your health care provider to discuss any symptoms of pelvic pain that you are experiencing. They can help detect or rule out any underlying causes of your pelvic pain, diagnose conditions and help treat your symptoms effectively.

• #10 Chronic Pelvic Pain: A Comprehensive Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9709590/

  The sudden development of the lower abdomen or pelvic pain in women who are actively engaged in sexual activity is the hallmark feature of PID. […] Pelvic congestion, similar to a scrotal varicocele in men, is very commonly observed in women between the ages of 20 and 30. […] Alterations in the gut microbiome, intestinal permeability, gut immune function, motility, visceral sensation, brain-gut connections, and psychosocial status are among the elements that play a vital role in the onset of IBS. […] Patients suffering from IBD come to outpatient departments complaining of chronic lower abdominal pain and pelvic pain. […] Advanced rectal tumors may spread to nearby tissues, such as the bladder and vagina, creating fistulae. They may also affect nearby nerves, causing pelvic, perineal, and sacral pain. […] Chronic pelvic pain is most often seen in women, but it usually doesn’t get diagnosed properly and hence is treated inadequately.

• #11 Pelvic pain

  https://www.nhs.uk/conditions/pelvic-pain/

  Pelvic pain is felt in the lower part of your tummy. […] There are lots of causes of pelvic pain. It might be caused by an infection or a condition affecting one of the organs in the pelvic area, such as the bowel or bladder. […] Common causes include: constipation or irritable bowel syndrome, urinary tract infections (UTIs), sexually transmitted infections (STIs). […] Pelvic pain is more common in women and common causes include: period pain, conditions affecting female reproductive organs, such as an ovarian cyst or endometriosis, pelvic pain in pregnancy. […] Pelvic pain can sometimes be caused by conditions affecting the prostate, such as prostatitis. […] Any treatment for pelvic pain will depend on the cause.

• #12 Chronic Pelvic Pain Syndrom: Symptoms and Treatments | Ada

  https://ada.com/conditions/chronic-pelvic-pain/

  It is estimated that 20 percent of women experience chronic pelvic pain as a result of an underlying condition or problem linked to the reproductive system. Possible gynecologic causes include: Endometriosis, Uterine fibroids, Adenomyosis, Pelvic inflammatory disease, Pelvic adhesive disease. […] Other, non-gynecologic causes of chronic pelvic pain include: Irritable bowel syndrome, Painful bladder syndrome and interstitial cystitis, Diverticulitis, Pelvic pain dysfunction, Abdominal myofascial pain, Fibromyalgia. […] In some cases, psychological problems may contribute to the onset of chronic pelvic pain. Moreover, it is thought that the psychological stress that can often result from chronic pelvic pain may help to perpetuate the condition. Possible psychological factors associated with chronic pelvic pain include: Physical, mental or sexual abuse, Depression, Anxiety.

• #13 Pelvic Pain | Conditions | UCSF Health

  https://www.ucsfhealth.org/conditions/pelvic-pain

  Chronic pelvic pain has many possible causes and may involve different systems in the body, including the urinary, reproductive gastrointestinal, musculosketal and neurological systems. Symptoms may vary depending on the cause. When we explore all the potential sources and address the issues we uncover, many women find relief. […] Endometriosis may cause pelvic pain, especially during menstruation. […] Adhesions can be difficult to diagnose, but in some cases the uterus and ovaries feel bound together on pelvic examination. […] Symptoms from adhesions include generalized pelvic discomfort or localized pain. […] Vulvodynia is pain at the opening to the vagina or the surrounding lips (vulva). […] Non-gynecologic problems can also cause pelvic pain. […] Musculoskeletal causes of pelvic pain are very common but are often overlooked. […] Chronic pain can be created by spasms of the muscles that line the pelvis, also known as the pelvic floor muscles. […] Many women with chronic pain suffer from anxiety, depression, or both, which worsens pain.

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

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

  Chronic pelvic pain (CPP) is a common problem and presents a major challenge to healthcare providers because of its unclear etiology, complex natural history, and poor response to therapy. […] Various reproductive, gastrointestinal (GI), urologic, and neuromuscular disorders may cause or contribute to chronic pelvic pain. Sometimes, multiple contributing factors may exist in a single patient. About 50-90% of patients with chronic pelvic pain have musculoskeletal pain and dysfunction. […] Common causes of chronic pelvic pain in men include chronic (nonbacterial) prostatitis, chronic orchalgia, and prostatodynia.

• #15 What causes chronic pelvic pain in women? – Cary OBGYN

  https://www.caryobgyn.com/what-causes-chronic-pelvic-pain-in-women/

  Chronic pelvic pain (CPP) is a complex condition that affects many women, causing persistent discomfort that can impact daily life. […] CPP can arise from a variety of sources, often making it challenging to pinpoint a single cause. Some common causes include: […] Gynecological Conditions: Endometriosis: A condition where tissue similar to the lining of the uterus grows outside it, causing pain, especially during menstruation. […] Urological Conditions: Interstitial Cystitis (Painful Bladder Syndrome): A chronic bladder condition causing pain, pressure, and frequent urination. […] Gastrointestinal Issues: Irritable Bowel Syndrome (IBS): A common digestive disorder that can cause abdominal pain, bloating, and changes in bowel habits. […] Musculoskeletal Problems: Pelvic Floor Dysfunction: Involves tight or weakened pelvic floor muscles, leading to pain and discomfort. […] Psychological Factors: Stress, anxiety, and depression can exacerbate chronic pain conditions, creating a complex cycle of pain and emotional distress.

• #16

  https://myhealth.alberta.ca/Health/pages/conditions.aspx?hwid=tv2262

  Chronic pelvic pain may be caused by problems in the female reproductive system. These include endometriosis, adenomyosis, and uterine fibroids. […] Other causes include scar tissue in the pelvic area after an infection or surgery, urinary or bowel diseases, and problems with the muscles, joints, and ligaments in the pelvis, lower back, or hips. […] Doctors don’t really understand all the things that can cause chronic pelvic pain. So sometimes, even with a lot of testing, the cause remains unknown. This doesn’t mean that there isn’t a cause or that your pain isn’t real. […] Sometimes, after a disease has been treated or an injury has healed, the affected nerves keep sending pain signals. This is called neuropathic pain. It may help explain why it can be so hard to find the cause of chronic pelvic pain.

• #16

  https://myhealth.alberta.ca/Health/pages/conditions.aspx?hwid=tv2262

  Risk factors for pelvic pain that becomes chronic include: a history of pelvic inflammatory disease, a history of physical or sexual abuse, a history of radiation treatment or surgery of the abdomen or pelvis, a history of depression, substance use disorder, a problem with the structure of the organs, pregnancy and childbirth that put stress on the back and pelvis. […] Chronic pelvic pain may include severe cramping during periods, pain during sex, or pain when you urinate or have a bowel movement. […] The pain can range from mild to severe or from dull to sharp. […] Surgery for pelvic pain is most likely to help when it’s done for a specific condition, like fibroids or endometriosis. […] Hysterectomy (removing the uterus) is sometimes done as a last-resort treatment. It may relieve pain in some cases, depending on what caused the pain. […] With any surgery for chronic pelvic pain such as hysterectomy or cutting of specific pelvic-area nerves, there’s a risk of lasting pain or pain that’s worse after surgery.

• #17 What causes persistent pelvic pain? | Jean Hailes | Jean Hailes

  https://www.jeanhailes.org.au/health-a-z/persistent-pelvic-pain/what-contributes-to-persistent-pelvic-pain

  Chronic pelvic pain syndrome is when you have persistent pelvic pain without an underlying biological condition. […] A range of psychological factors may influence persistent pelvic pain. […] There is a strong link between persistent pelvic pain and sleep problems, which can affect your quality of life. […] Traumatic experiences, such as sexual assault and abuse, may be linked to persistent pelvic pain. […] If you live with persistent pelvic pain, it can be hard to engage in social activities or connect with others. […] Your work environment can influence your pelvic pain, for example, if you are physically uncomfortable at work, you may experience more pain.

• #18 Chronic Pelvic Pain in Women Clinical Presentation: History, Physical Examination

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

  Patient history is important in cases of chronic pelvic pain. Because of the complex etiology and, often, the presence of associated disorders, a general approach with a thorough history that directs further evaluation and appropriate consultations is needed. […] Ask questions about factors that provoke or intensify pain. This may provide clues for possible etiologies or associated disorders. […] A good psychosocial or psychosexual history is needed when organic diseases are excluded, or coexisting psychiatric disorders are suggested. […] Sexual abuse occurring before age 15 years is associated with later development of chronic pelvic pain. […] A systematic review and meta-analysis revealed that among women with chronic pelvic pain, the prevalence of anxiety ranges from 22.8% to 79.0% and the prevalence of depression ranges from 14.0% to 56.9%. […] Somatization is a common associated psychologic disorder in women with chronic pelvic pain.

• #19 Chronic Pelvic Pain Syndrome: Symptoms, Causes, & More

  https://www.health.com/chronic-pelvic-pain-syndrome-8605950

  Chronic pelvic pain syndrome (CPPS) is a condition that occurs when a person experiences chronic pain in the pelvic region that lasts longer than six months. […] Researchers dont know the exact cause of chronic pelvic pain syndrome, but there are several health events that may play a role in the development of symptoms. For some people, symptoms begin after pelvic surgery. One study found that 20% of people experienced chronic pelvic pain six months after cesarean delivery (C-section). […] There also appears to be a link between chronic pelvic pain syndrome and a history of trauma. In a study of more than 700 people with CPPS, almost 50% of respondents reported a history of sexual assault or physical abuse, and approximately 31% had post-traumatic stress disorder (PTSD). […] When you experience an acute or chronic source of painwhether thats physical or emotionalyour brain may become more sensitive to the perception of pain. This process is called central sensitization. Although some people may be able to identify an event that triggered their chronic pain, many have an unknown cause.

• #20 Chronic pelvic pain’s persistence poses challenges for patients and health care providers – Norton Healthcare Provider Louisville, Ky.

  https://nortonhealthcareprovider.com/news/causes-of-chronic-and-acute-pelvic-pain/

  Endometriosis has been found to be present in approximately 70% of CPP patients, which is significantly higher than the 10% prevalence in the general population. Other coexisting contributors in CPP are irritable bowel syndrome (IBS), interstitial cystitis (IC), pelvic floor muscle tenderness and depression. […] The pathophysiology of CPP is complex, and, in addition to the pelvic component, it also can involve central sensitization. In this condition, pain signals are amplified, and patients may perceive pain from nonpainful stimuli. This is a result of changes in how the dorsal horn of the spinal cord, the somatosensory cortex and thalamus process pain. This explains why symptoms from conditions like endometriosis can persist in some cases even after seemingly successful treatment. […] Diagnosing CPP requires a thorough and nuanced approach. A comprehensive history and physical are paramount. A pelvic exam and pain-mapping can identify potential trigger points in the pelvic floor versus uterine or cervical tenderness. Tools such as the FABER (flexion, abduction and external rotation) test and the Carnett test can be helpful in differentiating myofascial from visceral causes of pelvic pain. Other tests might include sexually transmitted diseases testing, dynamic pelvic ultrasound, pelvic MRI, endometrial biopsy and diagnostic laparoscopy. Evaluations for conditions such as IC, IBS or diverticulitis, and psychological factors like depression and anxiety are also essential. Ultimately, the goal is to identify a possible source for the pain, although in many cases, testing fails to reveal a specific cause.

• #20 Chronic pelvic pain’s persistence poses challenges for patients and health care providers – Norton Healthcare Provider Louisville, Ky.

  https://nortonhealthcareprovider.com/news/causes-of-chronic-and-acute-pelvic-pain/

  Managing CPP requires a multifaceted approach, addressing the various contributors to the condition. […] Medical management for CPP often includes neuromodulators such as serotonin and norepinephrine reuptake inhibitors, tricyclics, and anticonvulsants. […] Given the complexity of CPP, practitioners must recognize when to refer patients to a pelvic health specialist, particularly in cases suspected of endometriosis. Signs warranting referral include persistent pelvic pain despite initial treatments, evidence of endometriosis on imaging or laparoscopy, and the presence of coexisting conditions like IC or severe dyspareunia. […] Chronic pelvic pain is a multifactorial and often challenging condition that requires a comprehensive and patient-centered approach. Health care providers must be aware that in most cases, effectively managing the condition requires addressing the “triad” of visceral, neuromuscular and psychosocial components. By incorporating this holistic approach, providers can significantly improve the quality of life for patients with CPP. For cases that are refractory or suggestive of underlying endometriosis, timely referral to a specialist is can help ensure optimal patient outcomes.

• #21 Chronic Pelvic Pain in Women | AAFP

  https://www.aafp.org/pubs/afp/issues/2016/0301/p380.html

  Chronic pelvic pain in women is defined as persistent, noncyclic pain perceived to be in structures related to the pelvis and lasting more than six months. Often no specific etiology can be identified, and it can be conceptualized as a chronic regional pain syndrome or functional somatic pain syndrome. […] It usually is not possible to identify a single etiology or definitive cure for chronic pelvic pain. In at least one-half of cases, there are one or more associated entities, such as irritable bowel syndrome, interstitial cystitis/painful bladder syndrome, endometriosis, or pelvic adhesions. […] Expert opinion suggests that in the absence of a single clear etiology, chronic pelvic pain can be conceptualized as a complex neuromuscular-psychosocial disorder consistent with a chronic regional pain syndrome (e.g., reflex sympathetic dystrophy) or functional somatic pain syndrome (e.g., irritable bowel syndrome, nonspecific chronic fatigue).

• #22 The causes of chronic pelvic pain syndrome in women

  https://www.topdoctors.co.uk/medical-articles/what-causes-chronic-pelvic-pain-syndrome-in-women

  Either way, whatever the original cause of the pain, once there is long-standing pain, quite often what happens is that the nerves get hyper-sensitised. This means that even when the original cause of the pain is gone, the nerves can become so hypersensitive that they can be stimulated to cause excessive pain to a stimulus that usually may not be painful. This is not just related to the nerves locally, but it is also the central perception of the pain in the brain that also is altered, so, at a very low threshold for having quite severe pain. This threshold can then be altered during the menstrual cycles, because of the changes in hormones.

• #23 EAU Guidelines on Chronic Pelvic Pain – Uroweb

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

  It is important to appreciate that nociception is the process of transmitting information to centres involved in perception of a stimulus that has the potential to cause tissue damage. Pain is far more complex and involves activation of the nociceptive pathways but also the emotional response. […] Neuronal sensitisation is responsible for a decrease in threshold and an increase in response duration and magnitude of dorsal horn neurons. […] Chronic pelvic pain is a clinical condition that results from complex interactions of physiological and psychological factors and has a direct impact on the social, personal and professional lives of men and women. […] Chronic pain as well as its treatment can impair our ability to express sexuality. […] Chronic pelvic pain leads to substantial impairment in QoL and several sexual dysfunctions. […] The quality of intimate relationships is closely connected with sexual function.

• #23 EAU Guidelines on Chronic Pelvic Pain – Uroweb

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

  Over the years much of the focus for CPPPS has been on peripheral-end-organ mechanisms, such as inflammatory or infective conditions. However, both animal and clinical research have indicated that many of the mechanisms for the CPPPSs are based within the CNS. […] Although ongoing peripheral organ pathology can produce persistent and chronic pain, the main focus of these guidelines is on CPPPSs in which no peripheral ongoing pathology (such as infection or neoplastic disease) is detected. The main exception is when pain is due to peripheral nerve damage. […] Risk factors include many different factors from various areas, including genetic, psychological state, recurrent physical trauma and endocrine factors. […] Genetics also play a role in assessing the risk of developing chronic pain. An individual who has one chronic pain syndrome is more likely to develop another. Family clusters of pain conditions are also observed and animals can be bred to be more prone to apparent chronic pain state. […] 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.

• #24 Chronic Pelvic Pain: Causes, Diagnosis & Treatment | Coyle Institute

  https://coyleinstitute.com/understanding-cpp/

  Chronic pelvic pain is a complex condition, primarily because it can be connected to so many different issues. For many patients, CPP arises from multiple sources and not just one problem. Gynecological, gastrointestinal and musculoskeletal issues can all cause CPP. This intricate web of potential causes complicates accurate diagnosis, as symptoms may overlap or vary widely among individuals. The challenge with CPP lies in pinpointing the root cause, which requires thorough patient evaluation and expertise in urogynecological conditions. […] CPP can stem from one or more issues and conditions, such as: Endometriosis, Pelvic inflammatory disease (PID), Uterine fibroids, Urinary tract issues like infections or interstitial cystitis (IC), Pelvic floor dysfunction, Pelvic congestion syndrome, Gastrointestinal disorders like irritable bowel syndrome or inflammatory bowel disease, Spasms linked to prior pelvic-area surgeries or procedures, Pelvic organ prolapse.

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