Etiology Of Chronic Pelvic Pain Research Articles

Chronic Pelvic Pain, Vulvar Pain Disorders, and Proteomics Profiles: New Discoveries, New Hopes.

Chronic pelvic pain (CPP) is generally defined as non-cyclic pain perceived in the pelvic area that has persisted from three to six months or longer and is unrelated to pregnancy. The etiology of CPP is complex, multifactorial, with heterogeneous presentation, and includes several diseases such as endometriosis, adenomyosis, and interstitial cystitis/bladder pain syndrome. It may also be associated with sexual dysfunction, musculoskeletal disorders, and comorbid psychiatric symptoms. Vulvar pain disorders (VPDs) are typically categorized separately from chronic pelvic pain; among all VPDs, vulvodynia is a chronic vulvar pain of unknown etiology, lasting at least 3 months and that might be associated with other potentially linked factors. Proteomics represents a useful approach to study the proteome profiles of clinical samples. In this review, we have considered a selection of articles that have analyzed the protein abundance and novel protein species from various biological samples, including eutopic/ectopic endometrium, urine, serum, follicular, peritoneal fluid, and cervical mucus, potentially involved in the pathogenesis and progression of CPP and VPDs. These findings could represent valuable targets for paving the way for the differential diagnosis and therapeutic management of CPP and VDPs, thereby optimizing both the prevention and treatment of these conditions.

MTHFR mutation: Another unifying etiology of chronic overlapping pain conditions

Introduction and Objective:Chronic pelvic pain (CPP) is a heterogeneous condition with multiple etiologies. Better characterization and understanding of CPP will lead to new therapeutic options and individualization of care, especially in patients with chronic overlapping pain syndromes (COPCs), which increase complexity of diagnosis. In this study, we present 6 patients with COPC and complex CPP, non-focal exam, who tested negative for small fiber neuropathy but who reported a history of methylenetetrahydrofolate reductase (MTHFR) mutations, and retrospective review of 76 patients with MTHFR mutation. This study explores through literature review whether MTHFR mutations play a role in the pathogenesis of chronic pelvic pain and overlapping pain conditions in a subset of patients with COPCs. Methods:Study design included an observational study of 6 patients, a retrospective cross-sectional study of 76 patients, and a literature review. Patients at our institution who tested positive for MTHFR mutations were included in the study; most had been seen in the cardiology/hematology clinics due to the association of MTHFR with clotting disorders. Chart review was performed to identify the presence of pain syndromes and specifically CPP. A review of the literature was undertaken to form a hypothesis for mechanisms that could explain the association between MTHFR mutations and chronic overlapping pain syndromes. Results:Of 76 patients with MTHFR mutations seen primarily in non-pain focused cardiology visits, 30 (39%) had some form of pain syndrome documented, 11 of whom (14%) specifically had CPP. The review below suggests that MTHFR plays a role in the maintenance of nerve tissue and conductance, neural tube defects, and paresthesia. Literature review revealed that MTHFR mutations have been linked with chronic pain and pathological processes such as chronic migraine, interstitial cystitis/bladder pain syndrome, sequelae of chronic Lyme disease, and fibromyalgia. Conclusions:The etiology of chronic pelvic pain is complex. Multisystem pain extending beyond the pelvis complicates the differential diagnosis but suggests a systemic cause. MTHFR mutations may play a unifying role in a subset of chronic pelvic pain patients with concomitant chronic overlapping pain syndromes. The mutations may affect folate metabolism pathways in these patients and hinder the ability to maintain nerve fibers over time, leading to dereliction of pain signal conduction. Disturbance of these pathways may have a role in chronic overlapping pain syndromes and complex pelvic pain.

Role of diagnostic laparoscopy in chronic pelvic pain in females: A study from tertiary care centre in Patna, Bihar

Chronic pelvic pain in females is one of the most bemusing problems that are faced by doctors in day to day practice as physical signs are nonspecific. Laparoscopy is one of the worthy tools in cases of chronic pelvic pain as not only it establishes the diagnosis but often treatment can be instituted in the same sitting. The present study aimed to evaluate whether diagnostic value of laparoscopy is worth in cases with chronic pelvic pain in females.This study was done in the department of General Surgery and Reproductive Medicine at Indira Gandhi Institute of Medical sciences, Patna, Bihar from July 2019 to March 2021. Seventy five female patients were included in this study. The analysis and interpretation of the data were performed using Microsoft excel. The quantitative data obtained were expressed as percentage in tabular form.: The studied patients were in the age group ranging from 15 – 65 years. Most patients 40 % (n=30) complaint of pain in right lower quadrant of abdomen. The most common finding during diagnostic laparoscopy was found to be tubercular pathology (22.67%) followed by pelvic adhesions (18.67%). Other diagnoses were pelvic inflammatory disease, endometriosis, cysts etc.Diagnostic Laparoscopy is a safe and effective tool to establish the aetiology of chronic pelvic pain and allows for appropriate interventions. It can serve as a time saving and cost effective implement for these patients with uncertain diagnosis.

Surgical interventions for the management of chronic pelvic pain in women.

Surgical interventions for the management of chronic pelvic pain in women.

Clinical Presentation, Patient Assessment, Anatomy, Pathophysiology, and Imaging of Pelvic Venous Disease.

Pelvic venous disorders (PeVDs) can result in several different clinical presentations, but can be challenging to distinguish from other etiologies of chronic pelvic pain (CPP). Clinical evaluation of CPP patients optimally should be performed in a multidisciplinary fashion and patients who may have PeVD should be referred for consultation with a vascular interventionalist whose evaluation would utilize an imaging workup to search for pelvic varices. Additionally, it is critical to quantify the quality-of-life effects of all CPP to determine the impact on the patient's overall health. Diagnostic imaging, including transabdominal and transvaginal ultrasound, computed tomography, magnetic resonance imaging, and venography, can be utilized to identify pelvic varices, as well as venous reflux and obstruction leading to CPP. The use of the SVP tool is important to classify PeVD patients based on their clinical symptoms, varicose veins, and pathophysiology for precise clinical communication and for reporting clinical research. The goal of this publication is to delineate the clinical presentation, anatomy, pathophysiology, and imaging evaluation of patients with CPP suspected of having PeVD.

Machine Learning Revealed New Correlates of Chronic Pelvic Pain in Women

Chronic pelvic pain affects one in seven women worldwide, and there is an urgent need to reduce its associated significant costs and to improve women's health. There are many correlated factors associated with chronic pelvic pain (CPP), and analyzing them simultaneously can be complex and involves many challenges. A newly developed interaction ensemble, referred to as INTENSE, was implemented to investigate this research gap. When applied, INTENSE aggregates three machine learning (ML) methods, which are unsupervised, as follows: interaction principal component analysis (IPCA), hierarchical cluster analysis (HCA), and centroid-based clustering (CBC). For our proposed research, we used INTENSE to uncover novel knowledge, which revealed new interactions in a sample of 656 patients among 25 factors: age, parity, ethnicity, body mass index, endometriosis, irritable bowel syndrome, painful bladder syndrome, pelvic floor tenderness, abdominal wall pain, depression score, anxiety score, Pain Catastrophizing Scale, family history of chronic pain, new or re-referral, age when first experienced pain, pain duration, surgery helpful for pain, infertility, smoking, alcohol use, trauma, dysmenorrhea, deep dyspareunia, CPP, and the Endometriosis Health Profile for functional quality of life. INTENSE indicates that CPP and the Endometriosis Health Profile are correlated with depression score, anxiety score, and the Pain Catastrophizing Scale. Other insights derived from these ML methods include the finding that higher body mass index was clustered with smoking and a history of life trauma. As well, sexual pain (deep dyspareunia) was found to be associated with musculoskeletal pain contributors (abdominal wall pain and pelvic floor tenderness). Therefore, INTENSE provided expert-like reasoning without training any model or prior knowledge of CPP. ML has the potential to identify novel relationships in the etiology of CPP, and thus can drive innovative future research.

Роль мышечно-фасциального синдрома и дисфункции в развитии синдрома хронической тазовой боли у женщин (Обзор литературы)

According to the classification of chronic pain syndromes proposed by the International Association for the Study of Pain (IASP) and due to the high clinical significance, chronic pelvic pain (CPP) represents an independent nosological structure and is defined as pain in the pelvic region (in the lower abdomen and the lower back), mainly between the navel and the pubic symphysis, which lasts for at least six months and disrupts the normal functioning of the body. Myofascial pelvic pain syndrome (MPPS) in English literature is included in the subgroup of etiology of CPP. Myofascial pelvic pain syndrome itself is not a direct threat to life and health and does not require urgent help. But today it is almost not diagnosed and is not considered as a source of chronic pain and dysfunction in the pelvic region. Such patients, unfortunately, are left without appropriate treatment and cannot get rid of the oppressive pain. They often receive unnecessary treatment, including surgical interventions. This problem causes neurosis, depression, sexual dysfunction and, as a result, leads to the deterioration in the quality of life. CPP can often have multiple causes and should be evaluated in terms of the pathology of various physiological systems, including reproductive, urogenital, gastrointestinal, musculoskeletal and nervous system. Based on a full picture of the multifactorial nature of CPP, the treatment of this category of patients requires an integrated approach involving specialists in various fields. Particular attention in the differential diagnosis of chronic pelvic pain in women should be paid to abdominal myofascial pain syndrome, the role of which is currently underestimated. Therefore, doctors should be aware of the main directions of diagnosis and treatment of CPP due to myofascial pain syndrome. Keywords: chronic pelvic pain, myofascial syndrome, nidling, post-isometric relaxation of muscles, relising.

Actinic cystitis associated with urinary tract infection by Candida glabrata as a differential diagnosis of pudendal neuralgia. Case report

ABSTRACT BACKGROUND AND OBJECTIVES: Chronic pelvic pain is still a little-known syndrome with different etiological agents, high morbidity rate, with little information about its etiopathogenesis, which makes its treatment difficult, with symptoms that significantly impact the patient’s quality of life. Among the conditions that lead to chronic pelvic pain, actinic cystitis stands out, a complication of pelvic radiotherapy. This pathology presents signs, symptoms, and complications similar to pudendal neuralgia. The objective of this report is to present one of the etiologies of chronic pelvic pain and its treatment. CASE REPORT: Sixty-three-year-old male patient who sought medical care with a history of chronic pelvic pain attributed to pudendal neuralgia. The diagnosis was actinic cystitis, resulting from pelvic radiotherapy for prostate adenocarcinoma and urinary tract infection by Candida glabrata, an opportunistic fungal agent. The patient was treated with fluconazole with total control of the painful symptoms and significant improvement in the quality of life. CONCLUSION: A case report with total pain control in a patient with an initial diagnosis of pudendal neuralgia, who after the clinical evaluation, imaging tests, cystoscopy, and lab tests was diagnosed with actinic cystitis associated to the urinary tract infection by Candida glabrata.

Coil-Eroded Left Ovarian Vein Presenting as Chronic Pelvic Pain and Genitofemoral Nerve Compression Syndrome

Chronic pelvic pain is a frequent health problem in women during childbearing age. The etiology of chronic pelvic pain includes irritable bowel syndrome, endometriosis, adenomyosis, pelvic congestion syndrome, urologic disorders, and psychosocial issues.

Chronic Pelvic Pain: The Neuropathic Pain Basis

Chronic pelvic pain (CPP) in both genders has been chiefly the province of surgical subspecialists. Morphologic end-organ processes have been studied for decades without significant advances in understanding the etiology of CPP or developing adequate therapeutic outcomes. The neurogenic basis of CPP has received little attention. Several peripheral nerves may be the source. The largest of these is a pudendal nerve and is the most important because it is a mixed nerve and affects sensory and motor symptoms in both the somatic and autonomic nervous systems. Nerve compression and stretch are the two most important etiologic factors. Practitioners can diagnose these painful neuropathies by a careful symptom history and physical examination. The most important diagnostic tool is sensory examination of the pudendal territory using pinprick. Various neurophysiologic tests can confirm pudendal neuropathy. The smaller peripheral nerves affect CPP. Because pudendal neuropathy is a tunnel syndrome related to cumulative, repetitive microtrauma, it can be treated accordingly. Treatment options include nerve protection, medications (analeptics, tricyclic amines), perineural infiltrations of local anesthetics with or without corticosteroids, and, in a significant minority, decompression of the pudendal nerves. The smaller nerves often respond to a program of postural correction and perineural anesthetic blockades. All patients require attention to central sensitization. Treatment success depends on the duration of symptoms, etiology, and severity of nerve damage. The last item can only be evaluated at surgery. Complete cures of CPP, treated using each modality, can be measured by validated symptom scores for as long as 13 years. To progress in the diagnosis and treatment of CPP, interspecialty studies are needed that distinctly separate neurogenic from nonneurogenic CPP. To date, this has not been done. Thus, diagnostic, etiologic, and treatment conclusions are quite limited. CPP provides a rich foundation for clinical research for neurologists. Key Words: abdominal cutaneous neuropathy, chronic pelvic pain, interstitial cystitis, irritable bowel syndrome, middle cluneal neuropathy, neurogenic pelvic pain, pudendal neuropathy, sexual dysfunction, thoracolumbar junction syndrome

Chronic Pelvic Pain: The Neuropathic Pain Basis

Chronic pelvic pain (CPP) in both genders has been chiefly the province of surgical subspecialists. Morphologic end-organ processes have been studied for decades without significant advances in understanding the etiology of CPP or developing adequate therapeutic outcomes. The neurogenic basis of CPP has received little attention. Several peripheral nerves may be the source. The largest of these is a pudendal nerve and is the most important because it is a mixed nerve and affects sensory and motor symptoms in both the somatic and autonomic nervous systems. Nerve compression and stretch are the two most important etiologic factors. Practitioners can diagnose these painful neuropathies by a careful symptom history and physical examination. The most important diagnostic tool is sensory examination of the pudendal territory using pinprick. Various neurophysiologic tests can confirm pudendal neuropathy. The smaller peripheral nerves affect CPP. Because pudendal neuropathy is a tunnel syndrome related to cumulative, repetitive microtrauma, it can be treated accordingly. Treatment options include nerve protection, medications (analeptics, tricyclic amines), perineural infiltrations of local anesthetics with or without corticosteroids, and, in a significant minority, decompression of the pudendal nerves. The smaller nerves often respond to a program of postural correction and perineural anesthetic blockades. All patients require attention to central sensitization. Treatment success depends on the duration of symptoms, etiology, and severity of nerve damage. The last item can only be evaluated at surgery. Complete cures of CPP, treated using each modality, can be measured by validated symptom scores for as long as 13 years. To progress in the diagnosis and treatment of CPP, interspecialty studies are needed that distinctly separate neurogenic from nonneurogenic CPP. To date, this has not been done. Thus, diagnostic, etiologic, and treatment conclusions are quite limited. CPP provides a rich foundation for clinical research for neurologists. Key Words: abdominal cutaneous neuropathy, chronic pelvic pain, interstitial cystitis, irritable bowel syndrome, middle cluneal neuropathy, neurogenic pelvic pain, pudendal neuropathy, sexual dysfunction, thoracolumbar junction syndrome

Chronic pelvic pain.

Chronic pelvic pain (CPP) affects about 10-40% of women presenting to a physician, and is characterised by pain within the minor pelvis persisting for over 6 months. The Medline database was searched using the key words 'chronic pelvic pain' and 'pelvic congestion syndrome', published in English during the past 15 years. The condition markedly deteriorates the quality of life of the affected. Its aetiology has not been fully described and elucidated, although organic, functional and psychosomatic factors are implicated. Pain associated with parametrial varices was defined as pelvis congestion syndrome (PCS). Since the aetiology of CPP is complex, multi-directional diagnostic procedures are required. The main diagnostic methods employed are imaging examinations (ultrasound, computer tomography, magnetic resonance). Advances in interventional radiology considerably contributed to the CPP treatment. Currently, embolization of parametrial vessels is one of the most effective methods to relieve pain associated with pelvic congestion syndrome. Due to the complex aetiology of chronic pelvic pain, the most beneficial effects are obtained when the therapy is based on cooperation of the gynaecologist, physiotherapist, psychologist and interventional radiologist.

Multidisciplinary Approach to Chronic Pelvic Pain

Chronic pelvic pain is a common medical condition affecting up to 16 percent of reproductive-aged women. There are many possible etiologies of chronic pelvic pain ranging from gynecologic to non-gynecologic. Treatment is based on the theorized cause but often refractory to traditional medical and surgical intervention. In over one third of the cases, the cause of chronic pelvic pain is unknown, even after an extensive workup including invasive surgical procedures. Women with chronic pelvic pain often have overlapping psychiatric diagnoses and history of physical or sexual abuse. Therefore, a multidisciplinary approach is recommended in order to address the patients’ medical, psychological, and social needs.

Risk factors for chronic pelvic pain: hospital-based case-control study from Turkey

Chronic pelvic pain (CPP) is a complicated condition that can have a large impact on life. The aetiology of CPP is often unclear and the origin appears to be multifactorial. This study aims to identify risk factors associated with CPP complaint in women. The study is a descriptive case–control study in nature. The study was conducted in one university and one state hospital. Women with CPP (n = 134) composed the case group while those who consulted to the polyclinics with other problems formed the control group (n = 383). The data were collected through a questionnaire which was prepared in light of the related literature and the ‘Pelvic Pain Assessment Form’ developed by the International Pelvic Pain Society. Women in the case and control groups were found to have similar socio-demographical features. This study has detected that CPP is associated with factors such as having a relative with recurrent pelvic pain complaint, having cancer or CPP history, having pain during menstruation, feeling of fullness in the abdominal region and stool consistency, recurrent urinary tract infections, having a diagnosed woman's disease (ovarian cyst, genital tract infection, prolapsus and menstrual irregularity), having had an abdominal operation, taking vaginal showers after sexual intercourse or for any other reason, falling down from height or having an accident that caused back damage, experiencing a sad event during childhood, being exposed to physical violence or forced to sexual intercourse. In Conclusion, this study has found that reproduction, urinary, gastrointestinal, musculoskeletal systems and psychological factors affect women with chronic pelvic pain.

Botulinum Toxin Type A (BOTOX) for Refractory Myofascial Pelvic Pain

The etiology of chronic pelvic pain is poorly understood. The condition is usually multifactorial; it has both physical and psychological components. Myofascial pain is a component of chronic pelvic pain. Management of myofascial pain is multidisciplinary and includes use of several different drugs, pelvic floor physical therapy/exercise, and trigger point injection of local anesthetic agents, steroids, botulinum toxin type A (Botox), and various other substances. A number of studies have shown that Botox improves pain symptoms resulting from muscle spasm in the head, neck, and back and other parts of the body. There are few data in the literature, however, on the effectiveness of Botox injection to the pelvic floor muscle (intralevator injection) in the treatment of myofascial pelvic pain. This retrospective cohort study investigated the effectiveness of intralevator injections of Botox for myofascial pelvic pain with a short tight pelvic floor that has been refractory to other treatments. Participants were women who had at least 1 intralevator injection of Botox (100–300 U) at a single institution from 2005 through 2010. The primary study outcome was patient-reported pain on levator palpation and symptom improvement. Secondary outcomes included postinjection complications and time to and number of second injections. Follow-up visits to assess pain were stratified into 2 time periods: less than 6 weeks after injection and 6 weeks or longer after injection. During digital palpation of the pelvic floor muscles at each visit, pain was assessed using a scale of 0 to 10, with 10 being the worst. Data are presented as median (interquartile range) or proportion. Thirty-one patients met study eligibility criteria; 2 were lost to follow-up and excluded from the analysis. The median age of the patients was 55.0 years (38.0–62.0 years). The median pain score was 9.5 (8.0–10.0) before the Botox injection. Of the 29 (93.5%) who returned for the first follow-up visit, 23 (79.3%) reported improvement in pain, whereas 6 (20.7%) reported no improvement. The median pain score with levator palpation at visit 1 was significantly lower than the preinjection pain score (P< 0.0001). Eighteen women (62.1%) returned for visit 2 and had a median pain score of 3.0, which remained lower than the preinjection score (P < 0.0001). More than half of the patients (51.7%) elected to have a second Botox injection; the median time from the first to the second injection was 4.0 months (3.0–7.0 months). Three women (10.3%) reported constipation and/or rectal pain, 2 patients (6.9%) reported fecal incontinence, and 3 (10.3%) developed de novo urinary retention. All adverse effects were reversible and resolved spontaneously. These findings indicate that intralevator injection of Botox is effective in women with refractory myofascial pelvic pain and has few self-limiting adverse effects. Placebo-controlled randomized trials are needed to fully establish both the long-term outcomes and adverse effects of Botox in this patient population.

Botulinum Toxin Type A (BOTOX) for Refractory Myofascial Pelvic Pain

To assess intralevator botulinum toxin type A (Botox) injections for refractory myofascial pelvic pain with short tight pelvic floor. Retrospective cohort study of all women with intralevator Botox injection (100-300 Units) from 2005 through 2010 for refractory myofascial pelvic pain. Primary outcomes were self-reported pain on palpation and symptom improvement. Secondary outcomes included postinjection complications and a second injection. Pain was assessed during digital palpation of the pelvic floor muscles using a scale of 0 to 10, with 10 being the worst possible pain. Follow-up occurred at less than 6 weeks after injection and again at 6 weeks or more. Data are presented as median (interquartile range) or proportion. Thirty-one patients met eligibility criteria; 2 patients were lostto follow-up and excluded. The median age was 55.0 years (38.0-62.0 years). Before Botox injection, the median pain score was 9.5 (8.0-10.0). Twenty-nine patients (93.5%) returned for the first follow-up visit; 79.3% reported improvement in pain, whereas 20.7% reported no improvement. The median pain with levator palpation was significantly lower than before injection (P<0.0001). Eighteen women (58.0%) had a second follow-up visit with a median pain score that remained lower than before injection (P<0.0001). Fifteen (51.7%) women elected to have a second Botox injection; the median time to the second injection was 4.0 months (3.0-7.0 months). Three (10.3%) women developed de novo urinary retention, 2 patients (6.9%) reported fecal incontinence, and 3 patients (10.3%) reported constipation and/or rectal pain; all adverse effects resolved spontaneously. Intralevator injection of Botox demonstrates effectiveness in women with refractory myofascial pelvic pain with few self-limiting adverse effects.

Complementary and Alternative Treatments for Chronic Pelvic Pain

Chronic pelvic pain (CPP) is a significant clinical entity that affects both men and women alike. The etiologies of CPP are multifactorial, and treatments are myriad. Complementary and Alternative Medicine (CAM) refers to non-allopathic health systems, and its use is popular in the United States. In particular, several recent studies have investigated the efficacy of various CAM practices in the treatment of CPP. The authors systematically evaluated recent literature in this area by searching the PubMed database for English-language studies published between January 2007 and August 2012.

Recent Trends in Chronic Pelvic Pain Diagnosis

Chronic pelvic pain is a common and significant disorder of women. It is estimated to have a prevalence of 3.8% in women. The etiology of chronic pelvic pain in women is poorly understood. Although a specific diagnosis is not found in the majority of cases, some common diagnoses include endometriosis, adhesions, irritable bowel syndrome, and interstitial cystitis. The initial history and physical examination can narrow the diagnostic possibilities, guide any subsequent evaluation, and rule out malignancy or significant systemic disease. If the initial evaluation does not reveal a specific diagnosis, a limited laboratory and ultrasound evaluation can clarify the diagnosis, as well as rule out serious disease and reassure the patient. Laboratory and imaging studies should be selectively utilized, as should laparoscopy. Conscious laparoscopic pain mapping has been proposed as a way to improve information derived from laparoscopic evaluations.

Chronic pelvic pain: gynaecological and non‐gynaecological causes and considerations for nursing care

Chronic pelvic pain (CPP) is one of the most difficult problems encountered by health professionals, and it is a very common gynaecological complaint in women of reproductive age. Any structure in the abdomen and/or pelvis could have a role in aetiology of CPP. The aetiology, however, is often unclear and the origin seems can be multifactorial. A multidisciplinary team can offer simultaneous assessment and management of somatic, behavioural and psychosocial components of the pain, and the nurse as an integral member of the healthcare team has an important role to play in ensuring effective care provision. The purpose of this review is to present comprehensive and contemporary information about the gynaecological and non‐gynaecological causes of CPP alongside an examination of the role of the nurse in caring for women who experience this problem.

Biomedical Perspectives About Women with Chronic Pelvic Pain: A Qualitative Analysis

Because the aetiology of chronic pelvic pain is complex, studies of the condition involve extensive investigation but provide few conclusions. Numerous studies have addressed the experiences of women with chronic pelvic pain, as well as the interaction between those women and their health care providers. Our objective was to investigate how physicians at a specialised clinic perceive the medical care provided to such women. This was a qualitative study employing semi-structured interviews and content analysis. We interviewed seven physicians at the Chronic Pelvic Pain Outpatient Clinic of the University Hospital, Faculty of Medicine of Ribeir?o Preto, University of S?o Paulo, Brazil. Medical training and practice constituted the central theme of the study, which was subdivided into categories addressing the influence that the current medical training has on the type of medical care provided to women with chronic pelvic pain. Medical practice has been characterised by a reductionist approach to health and illness, as well as by the fragmentation of health care. These characteristics are, to a certain extent, the result of the biomedical model of education, which has been predominant, ignoring social, cultural, psychological and emotional aspects. There is a need to shift the medical paradigms toward a humanistic model of health care. We hope that we have provided a critical view of current medical training and practice, as well as of their effects in various health care settings, particularly in the provision of care to women with chronic pelvic pain.