Key Learning Points

• Chronic pelvic pain (CPP) is pelvic pain that has persisted for six months or more. The amount of pain is often greater than the degree of pathology.

• Gynecologic causes of CPP can be divided into noncyclic and cyclic.

• Primary and secondary dysmenorrhea are cyclic. Primary dysmenorrhea is best treated with nonsteroidal antiinflammatory drugs (NSAID) and hormonal contraceptives; treatment of secondary dysmenorrhea depends on the etiology, but both may respond to menstrual supression.

• The most prevalent cyclic gynecologic cause of CPP is endometriosis.

• The pain with endometriosis is most likely associated with deeply infiltrating lesions. Numerous medical and surgical techniques are available for treatment.

• Pelvic pain, urinary urgency, urinary frequency, and frequent nocturia without evidence of urinary tract infection are suggestive of painful bladder syndrome or interstitial cystitis.

• Eliciting a trigger point or localizing tenderness to a specific branch of a somatic nerve is indicative of neuropathic pain. Injection of local anesthetic can be diagnostic as well as therapeutic.

• Psychological factors impact the perception and maintenance of pain. Depression and a history of physical and/or sexual abuse are common and should be addressed. Cognitive behavioral therapy is an important component of multidisciplinary management.

• Physical examination should encompass not only the pelvic viscera system, but also the musculoskeletal and neurologic systems.

• Management of CPP should involve a multidisciplinary approach for maximal benefit. Individual components of therapy may include:

- pharmacologic therapy: NSAIDs, antidepressants, anticonvulsants, and possibly narcotics, depending on the presumed etiology of the pain, trigger point injections, and local anesthetic nerve blocks.

- physical therapy including consideration of transcutaneous electric nerve stimulation (TENS) unit device in cases where there is a myofascial contribution to the pain.

• Vulvar vestibulitis, vestibulodynia vulvar dermatoses, cyclic vulvovaginitis, and dysesthetic vulvodynia are subtypes of vulvodynia.

• The etiology of vulvodynia may be infectious, trauma, allergens, underlying dermatologic, neurologic, urologic, or systemic conditions.

• Vulvar vestibulitis is vulvar pain characterized by entry dyspareunia, vestibular erythema, and vestibular tenderness.

• Therapies for vulvodynia depend on results of evaluation, and may include antifungal agents, antihistamines, topical corticosteroids, topical or injected local anesthetics, and estrogen.

• Tricyclic antidepressants, anticonvulsants, biofeedback and physical therapy of pelvic floor muscles, and cognitive-behavioral therapy may enhance the above therapies.

• Surgical intervention (perineoplasty - total or subtotal) should be offered in cases of vulvar vestibulitis resistant to medical therapy.

Naturally Cure Your Headaches

Naturally Cure Your Headaches

Are Headaches Taking Your Life Hostage and Preventing You From Living to Your Fullest Potential? Are you tired of being given the run around by doctors who tell you that your headaches or migraines are psychological or that they have no cause that can be treated? Are you sick of calling in sick because you woke up with a headache so bad that you can barely think or see straight?

Get My Free Ebook

Post a comment