Chronic pelvic pain in women, stages and methods of diagnosis (Literature review)

Abstract

Usually, women suffering from chronic pelvic pain experience it for some time and do not seek treatment until the pain becomes so severe that it adversely affects a woman’s normal daily functioning, preventing her from maintaining a normal lifestyle and leading to development of chronic pain syndrome. Chronic pelvic pain syndrome is often accompanied by behavioral disorders, cognitive, psychoemotional and sexual disorders, as well as symptoms of dysfunction of the lower urinary and digestive systems, pelvic organs, gynecological dysfunction, which are the result of neurobiological, physiological and sometimes anatomical changes in the body and central nervous system.Often a gynecologist automatically focuses exclusively on gynecological organs, assuming that they are the cause of the problem, but most often the cause of chronic pelvic pain is a group of factors. Disorders of the gastrointestinal, urological, and musculoskeletal systems are at least as common as disorders of the reproductive system in women with chronic pelvic pain. Therefore, diagnostic measures should be aimed at identifying all the causes which requires doctors to take a multidisciplinary approach to the diagnosis and management of chronic pelvic pain. The causes of the problem in most cases can be identified by a thorough history taking and physical examination, which should be more detailed than usual. As a diagnostic tool, it can minimize the need for expensive laboratory testing and imaging or risky surgery. The use of specialized assessment forms and questionnaires for chronic pelvic pain can be important and useful to ensure coverage of all critical points.When planning a diagnostic plan for women with chronic pelvic pain, it is important to consider the key role of the nervous system in the perception of pain. Experiencing pain for a long period of time can change how the brain perceives and processes pain signals, leading to an amplification of pain and cross-organ sensitization.Complicated differential diagnosis often causes the absence of a definitive diagnosis in most patients who complain of chronic pelvic pain. Therefore, during the first visit of the patient, it is sometimes impossible to immediately determine the cause of pain. Because the causes of many disorders associated with chronic pelvic pain have not been identified, most clinicians treat them empirically. Therefore, in the presence of several etio-pathogenetic factors, treatment of only some of them will lead to incomplete relief.The definition of «chronic pelvic pain» can hide many diseases, the detection of which requires the involvement of a multidisciplinary team of gynecologists, urologists, gastroenterologists, nephrologists, vascular surgeons, orthopedists, psychiatrists, psychologists and doctors of other specialties. However, it is mostly gynecologists who are the first to come into contact with this pathology because, in most cases, women who suffer from chronic pelvic pain first turn to them for help. That is why they should be the main members of the multidisciplinary team and take responsibility for its creation. Unfortunately, physicians often lack an interdisciplinary approach to the management of chronic pelvic pain, which complicates comprehensive assessment, diagnosis, and treatment and leads to frustration among women who go from one specialist to another without an adequate solution to their problem.