What is the definition of chronic pelvic pain?

Definition of Chronic Pelvic Pain

Chronic pelvic pain is defined as cyclical or noncyclical pain involving the pelvis, lower abdomen, vulva, vagina, or perineum that persists for at least 6 months. 1

Key Characteristics

• Chronic pelvic pain affects approximately one quarter of women worldwide and is the most common presenting complaint at gynecologic office visits 1
• It can be classified as either cyclical (related to menstrual cycle) or noncyclical pain 2
• The condition causes significant morbidity and has substantial public health impact and downstream costs 1
• It is considered a symptom rather than a diagnosis, often representing an underlying condition 3

Anatomical Considerations

• Pain may be localized to different areas:
  • Deep or internal pelvis 1
  • Perineum, vulva, or vagina 1
  • Lower abdomen 1

Etiological Framework

Chronic pelvic pain can be categorized by organ system involvement:

• Gynecological causes:

  • Endometriosis-related pain
  • Pelvic congestion syndrome
  • Pelvic inflammatory disease
  • Adenomyosis
  • Hydrosalpinx 2
  • Uterine fibroids 2

• Gastrointestinal causes:

  • Irritable bowel syndrome
  • Inflammatory bowel diseases
  • Abdominal hernias
  • Colorectal cancer 2

• Urological causes:

  • Interstitial cystitis/painful bladder syndrome
  • Urethral syndrome
  • Chronic recurrent cystitis 2, 4

• Musculoskeletal causes:

  • Pelvic girdle pain
  • Levator syndrome
  • Coccygodynia
  • Pelvic floor prolapse 2
  • Myofascial pain 1

Associated Conditions

• Chronic pelvic pain frequently coexists with:
  • Other functional somatic pain syndromes (e.g., irritable bowel syndrome, nonspecific chronic fatigue syndrome) 4
  • Mental health disorders (e.g., posttraumatic stress disorder, depression) 4, 3
  • Chronic overlapping pain conditions (COPCs) 5

Clinical Significance

• In postmenopausal women, special attention should be given to vaginal bleeding and suspected adnexal masses due to the risk of endometrial and ovarian neoplasia 1
• The condition should be approached as a chronic regional pain syndrome or functional somatic pain syndrome when no specific etiology can be identified 4
• Central sensitization may play a role in chronic pelvic pain, particularly when multiple pain conditions overlap 5

Management Considerations

• Treatment should address both peripheral pain generators and central sensitization when present 5
• A multidisciplinary approach is typically required, involving primary care, gynecology, pain management, psychiatry, gastroenterology, and urology 3
• First-line treatments often include conservative care such as exercise, counseling, and musculoskeletal therapy 6