Chronic Pelvic Pain in Women

Definition

Chronic pelvic pain (CPP) in women is non-cyclical pain of at least 6 months' duration perceived in the pelvic region, which may involve gynecologic, urologic, gastrointestinal, musculoskeletal, or neurologic systems.

Epidemiology

• Affects 15–20% of women of reproductive age worldwide.
• More common in women with a history of pelvic surgery, endometriosis, or pelvic infections.
• Major cause of healthcare visits and decreased quality of life.
• Often underdiagnosed or misattributed to psychological factors.
• Can result in absenteeism and psychosocial stress.

Etiology

• Gynecologic: endometriosis, adenomyosis, pelvic inflammatory disease, ovarian cysts, adhesions.
• Urologic: interstitial cystitis/bladder pain syndrome, recurrent urinary tract infections.
• Gastrointestinal: irritable bowel syndrome, inflammatory bowel disease, chronic constipation.
• Musculoskeletal: pelvic floor dysfunction, myofascial pain, sacroiliac joint dysfunction.
• Neurologic: nerve entrapment, neuropathic pain.
• Psychological factors: anxiety, depression, history of abuse.

Pathophysiology

• Chronic inflammation and sensitization of pelvic organs and nerves.
• Neuropathic mechanisms: peripheral and central sensitization.
• Muscle spasm and pelvic floor dysfunction contribute to pain perpetuation.
• Hormonal influences may exacerbate symptoms (e.g., endometriosis).
• Multifactorial etiology with overlapping organ systems.