Chronic Pelvic Pain Syndrome

Chronic Pelvic Pain Syndrome is a distinct nosological entity characterized by pelvic area pain (below the umbilical ring) lasting for no less than 6 months.

Pain intensity often does not correlate with the degree of visible tissue damage and is accompanied by negative cognitive, behavioral, and sexual consequences.

Etiology and pathophysiology

The pathogenesis of CPPS is characterized by the phenomenon of “central sensitization.” Initial noxious (inflammatory) stimulation from the target organ (in cases of endometriosis, adhesions) causes neuroplastic changes in the dorsal horns of the spinal cord and brain cortex.

The pain system begins to function autonomously, lowering the pain sensitivity threshold (hyperalgesia), leading to the formation of a neuropathic pain component. Frequently, secondary myofascial pelvic floor syndrome (levator muscle spasms) is involved. The pain “detaches” from the original cause and becomes an independent disorder of the nervous system.

Clinical significance

In gynecological practice, CPPS is most often associated with “minor” (peritoneal) forms of external endometriosis, varicose veins of the pelvis (pelvic congestion syndrome), and adhesions following pelvic inflammatory diseases (PID). The diagnosis is established by excluding acute pathology. Treatment requires a multidisciplinary approach involving neurologists, psychotherapists, and physiotherapists.