Pelvic pain

• Pelvic girdle pain
• Ectopic pregnancy—a pregnancy implanted outside the uterus.^[11]

Gynecologic (from more common to less common)

• Dysmenorrhea—pain during the menstrual period.
• Endometriosis—pain caused by uterine tissue that is outside the uterus. Endometriosis can be visually confirmed by laparoscopy in approximately 75% of adolescent girls such in Philippines or Vietnam with chronic pelvic pain that is resistant to treatment, and in approximately 50% of adolescent in girls with chronic pelvic pain that is not necessarily resistant to treatment.^[12]
• Pelvic inflammatory disease—pain caused by damage from infections.^[13]
• Adenomyosis. Adenomyosis is a medical condition characterized by the growth of cells that build up the inside of the uterus (endometrium) atypically located within the cells that put up the uterine wall (myometrium), as a result, thickening of the uterus occurs.
• long term condition believed to be due to enlarged veins
  in the lower abdomen.
• Polycystic ovary syndrome. , or PCOS, is the most common endocrine disorder in women of reproductive age.
• Ovarian cysts—the ovary produces a large, painful cyst, which may rupture.
• Asherman's syndrome (AS) is an acquired uterine condition that occurs when scar tissue (adhesions) form inside the uterus and/or the cervix.
• Ovarian torsion—the ovary is twisted in a way that interferes with its blood supply. (pain on one side only)
• Alcock's canal
  .

Abdominal

• Loin pain hematuria syndrome.
• Proctitis—infection or inflammation of the anus or rectum.
• Colitis—infection or inflammation of the colon.
• Appendicitis—infection or inflammation of the bowel.

Diagnosis

Females

The absence of visible pathology in chronic pain syndromes should not form the basis for either seeking psychological explanations or questioning the reality of the patient’s pain.^[14] Instead it is essential to approach the complexity of chronic pain from a psychophysiological perspective which recognises the importance of the mind-body interaction. Some of the mechanisms by which the limbic system impacts on pain, and in particular myofascial pain, have been clarified by research findings in neurology and psychophysiology.^[15]

Males

In chronic pelvic pain, there are no standard diagnostic tests in males; diagnosis is by exclusion of other disease entities.^[16]

Treatment

Nerve blocks aimed at the pudendal nerve, superior hypogastric plexus and ganglion of impar have shown to be effective for treating certain types of pelvic pain that do not respond to conservative treatment.^[17]

Neuromodulation has been explored as a potential treatment option for some time. Traditional spinal cord stimulation, also known as dorsal column stimulation has been inconsistent in treating pelvic pain: there is a high failure rate with these traditional systems due to the inability to affect all of the painful areas and there remains to be consensus on where the optimal location of the spinal cord this treatment should be aimed.^[18] As the innervation of the pelvic region is from the sacral nerve roots, previous treatments have been aimed at this region; however pain pathways seem to elude treatment solely directed at the level of the spinal cord (perhaps via the sympathetic nervous system)^[19] leading to failures. Spinal cord stimulation aimed at the mid- to high-thoracic region of the spinal cord have produced some positive results.^[20] A newer form of spinal cord stimulation called dorsal root ganglion stimulation (DRG) has shown a great deal of promise for treating pelvic pain due to its ability to affect multiple parts of the nervous system simultaneously - it is particularly effective in patients with "known cause" (i.e. post surgical pain, endometriosis, pudendal neuralgia, etc.).^[21][22]

There are a number of "alternative" therapies that have been offered for pelvic pain based on the notion that they are "non-invasive" however they are not supported by evidenced-based medicine.

Vibrators have also been found to be effective at addressing Pelvic Pain.^[25][26] Sometimes described as a massager, the vibrator is used on the body to produce sexual stimulation. Examples of FDA registered vibrators for sexual arousal disorder include MysteryVibe's Crescendo^[25][27][28] and Intimate Rose's Pelvic Wand.

Females

Many women will benefit from a consultation with a physical therapist, a trial of anti-inflammatory medications, hormonal therapy, or even neurological agents. A hysterectomy is sometimes performed however this should only be explored as a last resort given the fact that it is often not effective in treating neuropathic pain.^[29]

Males

Epidemiology

Female

Most women, at some time in their lives, experience pelvic pain. As girls enter puberty, pelvic or abdominal pain becomes a frequent complaint. Chronic pelvic pain is a common condition with rate of

According to the CDC, Chronic pelvic pain (CPP) accounted for approximately 9% of all visits to gynecologists in 2007.^[31] In addition, CPP is the reason for 20-30% of all laparoscopies in adults.^[32] Pelvic girth pain is frequent during pregnancy.^[33]

Social implications

Issues have been found in current procedures for the treatment of chronic pelvic pain (CPP). These relate primarily with regard to the conceptual dichotomy between an ‘organic’ genesis of pain, where the presence of tissue damage is presumed, and a ‘psychogenic’ origin, where pain occurs despite a lack of damage to tissue.^[34] CPP literature in medicine and psychiatry reflects a paradigm where unproblematically observable ‘organic’ processes are causally and sequentially explained, despite evidence in favour of a possible model which accounts for the “complex role played by meaning and consciousness” in the experience of pain.^[34] While in the literature of causal mechanisms reference is made to ‘subjective’ aspects of pain, current models do not provide a means through which these aspects may be accessed or understood.^[34] Without interpretive or ‘subjective’ approaches to the pain experienced by patients, medical understandings of CPP are fixed within ‘organic’ sequences of the “purely object” body conceptually separated from the patient.^[34] Despite the prevalence of this wider understanding of the biological genesis of pain, alternate diagnosis and treatments of CPP in multidisciplinary settings have shown high success rates for people for whom ‘organic’ pathology has been unhelpful.^[34]

References