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{{Infobox symptom
{{Infobox medical condition (new)
| Name = Pelvic and perineal pain
| name = Pelvic and perineal pain
| Image = Endometrioma3.jpg
| synonyms =
| Caption = [[Micrograph]] showing [[endometriosis]] ([[H&E stain]]), a common cause of '''chronic pelvic pain''' in women.
| image = Endometrioma3.jpg
| caption = [[Micrograph]] showing [[endometriosis]] ([[H&E stain]]), a common cause of chronic pelvic pain in women.
| DiseasesDB =
| pronounce =
| ICD10 = {{ICD10|R|10|.2|n|80}}
| field =
| ICD9 = 625.9
| symptoms =
| ICDO =
| complications =
| OMIM =
| onset =
| MedlinePlus =
| duration =
| types =
| eMedicineSubj =
| causes =
| eMedicineTopic =
| risks =
| eMedicine_mult =
| MeshID =
| diagnosis =
| differential =
| prevention =
| treatment =
| medication =
| prognosis =
| frequency = 43% worldwide<ref name=Brown2018>{{cite journal |last1=Brown |first1=CL |last2=Rizer |first2=M |last3=Alexander |first3=R |last4=Sharpe EE |first4=3rd |last5=Rochon |first5=PJ |title=Pelvic Congestion Syndrome: Systematic Review of Treatment Success. |journal=Seminars in Interventional Radiology |date=March 2018 |volume=35 |issue=1 |pages=35–40 |doi=10.1055/s-0038-1636519 |pmid=29628614|pmc=5886772 }}</ref>
| deaths =
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}}
'''Pelvic pain''' is [[pain]] in the area of the [[pelvis]]. [[Acute (medicine)|Acute pain]] is more common than [[chronic pain]].<ref>{{Cite web |title=Acute Pain vs. Chronic Pain: Differences & Causes |url=https://my.clevelandclinic.org/health/articles/12051-acute-vs-chronic-pain |access-date=2022-04-23 |website=Cleveland Clinic}}</ref> If the pain lasts for more than six months, it is deemed to be chronic pelvic pain.<ref>{{Citation |last1=Dydyk |first1=Alexander M. |title=Chronic Pelvic Pain |date=2022 |url=http://www.ncbi.nlm.nih.gov/books/NBK554585/ |work=StatPearls |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=32119472 |access-date=2022-04-23 |last2=Gupta |first2=Nishant}}</ref><ref>{{cite web|title=Chronic pelvic pain|url=https://www.acog.org/~/media/For%20Patients/faq099.pdf?dmc=1&ts=20140608T0831254822|publisher=ACOG|access-date=11 June 2014}}</ref> It can affect both the male and female pelvis.
'''Pelvic pain''' is a symptom that can affect both women and men. The pelvic [[pain]] that persists for a period of 3 months or more to be considered '''chronic''' while less than this duration is considered '''acute'''. The pain may indicate the existence of poorly-understood conditions that likely represent abnormal psychoneuromuscular function.


Common causes in include: [[endometriosis]] in women, [[bowel adhesion]]s, [[irritable bowel syndrome]], and [[interstitial cystitis]].<ref>{{Cite journal |last1=Moore |first1=Jane |last2=Kennedy |first2=Stephen |date=2000-06-01 |title=Causes of chronic pelvic pain |url=https://www.sciencedirect.com/science/article/pii/S1521693499900822 |journal=Best Practice & Research Clinical Obstetrics & Gynaecology |language=en |volume=14 |issue=3 |pages=389–402 |doi=10.1053/beog.1999.0082 |pmid=10962633 |issn=1521-6934}}</ref><ref name=AFP2008>{{cite journal|last1=Ortiz|first1=DD|title=Chronic pelvic pain in women.|journal=American Family Physician|date=Jun 1, 2008|volume=77|issue=11|pages=1535–42|pmid=18581833}}</ref> The cause may also be a number of poorly understood conditions that may represent abnormal psychoneuromuscular function.
==Female==
Most women, at some time in their lives, experience pelvic pain. Many different etiologies have been proposed, including:
* [[endometriosis]]
* infection or post-infectious neurological hypersensitivity
* exaggerated bladder, bowel, or uterine pain sensitivity (also known as visceral pain)
* ovarian cysts, uterine [[leiomyoma]] - often found in asymptomatic patients as well, however
* less common emergencies: ovarian torsion - sudden loss of circulation to the ovary, appendicitis - infection of one part of the intestine, with right lower abdominal pain
* [[pelvic girdle pain]] (SPD or DSP)
Women with symptoms of pain may want to see a gynecologist if problems don't go away after a few days, and workup should begin with a careful history and examination, followed by a pregnancy test. Some women may also need bloodwork or additional imaging studies, and a handful may also benefit from having surgical evaluation using small telescopes ([[laparoscopy]]). Many women will also benefit from a consultation with a physical therapist, a trial of anti-inflammatory medications, hormonal therapy, or even neurological agents.


The role of the nervous system in the genesis and moderation of pain is explored.<ref>{{Cite journal |last1=Moore |first1=J. |last2=Kennedy |first2=S. |date=June 2000 |title=Causes of chronic pelvic pain |url=https://pubmed.ncbi.nlm.nih.gov/10962633/ |journal=Baillière's Best Practice & Research. Clinical Obstetrics & Gynaecology |volume=14 |issue=3 |pages=389–402 |doi=10.1053/beog.1999.0082 |pmid=10962633}}</ref> The importance of psychological factors is discussed, both as a primary cause of pain and as a factor which affects the pain experience. As with other chronic syndromes, the biopsychosocial model offers a way of integrating physical causes of pain with psychological and social factors.<ref>{{Cite journal |last1=Meints |first1=S.M. |last2=Edwards |first2=R.R. |date=2018-12-20 |title=Evaluating Psychosocial Contributions to Chronic Pain Outcomes |journal=Progress in Neuro-psychopharmacology & Biological Psychiatry |volume=87 |issue=Pt B |pages=168–182 |doi=10.1016/j.pnpbp.2018.01.017 |issn=0278-5846 |pmc=6067990 |pmid=29408484}}</ref>
This is a condition that although common, direly needs to be studied more closely.


==Terminology==
As girls enter gynecologic maturity, pelvic or abdominal pain becomes a frequent complaint.
Pelvic pain is a general term that may have many causes, listed below.


The subcategorical term '''[[urologic chronic pelvic pain syndrome]] (UCPPS)''' is an umbrella term adopted for use in research into ''urologic'' pain syndromes associated with the male and female pelvis.<ref>{{Cite journal |last1=Clemens |first1=J. Quentin |last2=Mullins |first2=Chris |last3=Ackerman |first3=A. Lenore |last4=Bavendam |first4=Tamara |last5=van Bokhoven |first5=Adrie |last6=Ellingson |first6=Benjamin M. |last7=Harte |first7=Steven E. |last8=Kutch |first8=Jason J. |last9=Lai |first9=H. Henry |last10=Martucci |first10=Katherine T. |last11=Moldwin |first11=Robert |date=March 2019 |title=Urologic chronic pelvic pain syndrome: insights from the MAPP Research Network |journal=Nature Reviews. Urology |volume=16 |issue=3 |pages=187–200 |doi=10.1038/s41585-018-0135-5 |issn=1759-4820 |pmc=6800057 |pmid=30560936}}</ref> UCPPS specifically refers to [[chronic prostatitis/chronic pelvic pain syndrome]] (CP/CPPS) in men and [[interstitial cystitis]] or painful bladder syndrome (IC/PBS) in women.<ref name="pmid32378039">{{cite journal |vauthors=Adamian L, Urits I, Orhurhu V, Hoyt D, Driessen R, Freeman JA, Kaye AD, Kaye RJ, Garcia AJ, Cornett EM, Viswanath O |title=A Comprehensive Review of the Diagnosis, Treatment, and Management of Urologic Chronic Pelvic Pain Syndrome |journal=Curr Pain Headache Rep |volume=24 |issue=6 |pages=27 |date=May 2020 |pmid=32378039 |doi=10.1007/s11916-020-00857-9 |s2cid=218513050 |url=}}</ref>
Chronic pelvic pain (CPP) accounts for 10% of all visits to gynecologists. In addition, CPP is the reason for 20 - 30% of all laparoscopies in adults.


==Cause==
* Gynecologic Etiologies
{{Further|List of causes of genital pain}}Genital [[pain]] and pelvic pain can arise from a variety of conditions, crimes, [[Major trauma|trauma]], medical treatments, physical diseases, [[mental illness]] and infections. In some instances the pain is consensual and self-induced. [[Self-defeating personality disorder|Self-induced pain]] can be a cause for concern and may require a [[Psychiatry|psychiatric]] evaluation.
** [[Dysmenorrhea]]
** [[Endometriosis]]
** Müllerian abnormalities
** [[Pelvic inflammatory disease]]
** Ovarian abnormalities


===Female===
* Abdominal Etiologies
Many different conditions can cause female pelvic pain including:
** [[Loin pain hematuria syndrome]]
** [[Proctitis]]
** [[Colitis]]


;Related to pregnancy
==Male==
* [[Pelvic girdle pain]]
{{main|Chronic prostatitis/chronic pelvic pain syndrome}}
* [[Ectopic pregnancy]]—a pregnancy implanted outside the uterus.<ref>{{Cite web |title=Ectopic Pregnancy: Symptoms, Causes, Treatments & Tests |url=https://my.clevelandclinic.org/health/diseases/9687-ectopic-pregnancy |access-date=2022-04-23 |website=Cleveland Clinic}}</ref>
Men also experience chronic pelvic pain. In men it is called Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) and is also known as ''chronic nonbacterial prostatitis''. Men in this category have no known infection, but do have extensive pelvic pain lasting more than 3 months.<ref name="pmid12195565">{{cite journal |author=Luzzi GA |title=Chronic prostatitis and chronic pelvic pain in men: aetiology, diagnosis and management |journal=Journal of the European Academy of Dermatology and Venereology : JEADV |volume=16 |issue=3 |pages=253–6 |year=2002 |pmid=12195565 |doi=10.1046/j.1468-3083.2002.00481.x}}</ref> There are no standard diagnostic tests; diagnosis is by exclusion of other disease entities. Multimodal therapy is the most successful treatment option,<ref name="pmid15978236">{{cite journal |author=Potts JM |title=Therapeutic options for chronic prostatitis/chronic pelvic pain syndrome |journal=Current urology reports |volume=6 |issue=4 |pages=313–7 |year=2005 |pmid=15978236 |doi=10.1007/s11934-005-0030-5}}</ref> and includes [[Alpha blockers|α-blockers]],<ref name="pmid16870951">{{cite journal |author=Yang G, Wei Q, Li H, Yang Y, Zhang S, Dong Q |title=The effect of alpha-adrenergic antagonists in chronic prostatitis/chronic pelvic pain syndrome: a meta-analysis of randomized controlled trials |journal=J. Androl. |volume=27 |issue=6 |pages=847–52 |year=2006 |pmid=16870951 |doi=10.2164/jandrol.106.000661 |quote=...treatment duration should be long enough (more than 3 months)}}</ref> phytotherapy,<ref name="pmid10604689">{{cite journal |author=Shoskes DA, Zeitlin SI, Shahed A, Rajfer J |title=Quercetin in men with category III chronic prostatitis: a preliminary prospective, double-blind, placebo-controlled trial |journal=Urology |volume=54 |issue=6 |pages=960–3 |year=1999 |pmid=10604689 |doi=10.1016/S0090-4295(99)00358-1}}</ref><ref name="pmid16413333">{{cite journal |author=Elist J |title=Effects of pollen extract preparation Prostat/Poltit on lower urinary tract symptoms in patients with chronic nonbacterial prostatitis/chronic pelvic pain syndrome: a randomized, double-blind, placebo-controlled study |journal=Urology |volume=67 |issue=1 |pages=60–3 |year=2006 |pmid=16413333 |doi=10.1016/j.urology.2005.07.035}}</ref> and protocols aimed at quieting the pelvic nerves through myofascial trigger point release with psychological re-training for anxiety control.<ref name="pmid15947608">{{cite journal |author=Anderson RU, Wise D, Sawyer T, Chan C |title=Integration of myofascial trigger point release and paradoxical relaxation training treatment of chronic pelvic pain in men |journal=J. Urol. |volume=174 |issue=1 |pages=155–60 |year=2005 |pmid=15947608 |doi=10.1097/01.ju.0000161609.31185.d5}}</ref><ref name="pmid16952676">{{cite journal |author=Anderson RU, Wise D, Sawyer T, Chan CA |title=Sexual dysfunction in men with chronic prostatitis/chronic pelvic pain syndrome: improvement after trigger point release and paradoxical relaxation training |journal=J. Urol. |volume=176 |issue=4 Pt 1 |pages=1534–8; discussion 1538–9 |year=2006 |pmid=16952676 |doi=10.1016/j.juro.2006.06.010}}</ref> Antibiotics are not recommended.<ref name="pmid15492337">{{cite journal |author=Alexander RB, Propert KJ, Schaeffer AJ, ''et al.'' |title=Ciprofloxacin or tamsulosin in men with chronic prostatitis/chronic pelvic pain syndrome: a randomized, double-blind trial |journal=Ann. Intern. Med. |volume=141 |issue=8 |pages=581–9 |year=2004 |pmid=15492337 |doi=}}</ref><ref name="pmid14550427">{{cite journal |author=Nickel JC, Downey J, Clark J, ''et al.'' |title=Levofloxacin for chronic prostatitis/chronic pelvic pain syndrome in men: a randomized placebo-controlled multicenter trial |journal=Urology |volume=62 |issue=4 |pages=614–7 |year=2003 |pmid=14550427 |doi=10.1016/S0090-4295(03)00583-1}}</ref>


; Gynecologic (from more common to less common)
===Differential diagnosis===
* [[Dysmenorrhea]]—pain during the menstrual period.
In men, chronic pelvic pain (category IIIB) is often misdiagnosed as [[chronic bacterial prostatitis]] and needlessly treated with antibiotics exposing the patient to inappropriate antibiotic use and unnecessarily to adverse effects with little if any benefit in most cases. Within a Bulgarian study, where by definition all patients had negative microbiological results, a 65% adverse drug reaction rate was found for patients treated with ciprofloxacin in comparison to a 9% rate for the placebo patients. This was combined with a higher cure rate (69% v 53%) found within the placebo group.<ref>{{cite web |author=J. Dimitrakov |coauthors=J. Tchitalov, T. Zlatanov, D. Dikov |title=A Prospective, Randomized, Double-Blind, Placebo-Controlled Study Of Antibiotics For The Treatment Of Category Iiib Chronic Pelvic Pain Syndrome In Men |url=http://www.prostatitis.org/a92000.html |publisher=Third International Chronic Prostatitis Network |accessdate=4 September 2009 |quote=The results of our study show that antibiotics have an unacceptably high rate of adverse side effects as well as a statistically insignificant improvement over placebo...}}</ref>
* [[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.<ref>{{Cite journal | last1 = Janssen | first1 = E. B. | last2 = Rijkers | first2 = A. C. M. | last3 = Hoppenbrouwers | first3 = K. | last4 = Meuleman | first4 = C. | last5 = d'Hooghe | first5 = T. M. | title = Prevalence of endometriosis diagnosed by laparoscopy in adolescents with dysmenorrhea or chronic pelvic pain: A systematic review | doi = 10.1093/humupd/dmt016 | journal = Human Reproduction Update | volume = 19 | issue = 5 | pages = 570–582 | year = 2013 | pmid = 23727940| doi-access = free }}</ref>
* [[Pelvic inflammatory disease]]—pain caused by damage from infections.<ref>{{Cite web |title=Pelvic inflammatory disease (PID) - Symptoms and causes |url=https://www.mayoclinic.org/diseases-conditions/pelvic-inflammatory-disease/symptoms-causes/syc-20352594 |access-date=2022-04-23 |website=Mayo Clinic |language=en}}</ref>
* [[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.
* [[Pelvic congestion syndrome]] -- , also known as '''pelvic vein incompetence''', is a [[Chronic (medicine)|long term]] condition believed to be due to [[Varicose veins|enlarged veins]] in the lower abdomen.
* [[Polycystic ovary syndrome]]. , or '''PCOS''', is the most common [[Endocrine system|endocrine]] disorder in women of reproductive age.
* [[Ovarian cyst]]s—the [[ovary]] produces a large, painful cyst, which may rupture.
* [[Asherman's syndrome]] ('''AS''') is an acquired uterine condition that occurs when scar tissue ([[Adhesion (medicine)|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)
* [[Pudendal nerve entrapment]]. ('''PNE'''), also known as '''Alcock canal syndrome''', is an uncommon source of [[chronic pain]] in which the [[pudendal nerve]] (located in the [[pelvis]]) is entrapped or compressed in [[Alcock’s canal|Alcock's canal]].


; Abdominal
==See also==
* [[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==
* Abdominal [[Adhesion (medicine)|adhesions]]
* [[Coccydynia| Coccydynia (coccyx pain, tailbone pain)]]
*[[CP/CPPS]]


==References==
===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.<ref>{{Cite book |last=Institute of Medicine (US) Committee on Advancing Pain Research |first=Care |url=https://www.ncbi.nlm.nih.gov/books/NBK92525/ |title=Introduction |date=2011 |publisher=National Academies Press (US) |language=en}}</ref> 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.<ref>{{Cite journal |last1=Golanska |first1=Paulina |last2=Saczuk |first2=Klara |last3=Domarecka |first3=Monika |last4=Kuć |first4=Joanna |last5=Lukomska-Szymanska |first5=Monika |date=2021-07-23 |title=Temporomandibular Myofascial Pain Syndrome—Aetiology and Biopsychosocial Modulation. A Narrative Review |journal=International Journal of Environmental Research and Public Health |volume=18 |issue=15 |pages=7807 |doi=10.3390/ijerph18157807 |issn=1661-7827 |pmc=8345811 |pmid=34360099|doi-access=free }}</ref>
{{reflist}}
* Milburn A, Reiter R, Rhomberg A: Multi-disciplinary approach to chronic pain. Obstet Gynecol Clin 1993;20:643 - 661.
* Stovall DW: Endometriosis associated pelvic pain: Evidence for an association between the stage of disease and a history of chronic pelvic pain. Fertil Steril 1997;68:13 - 17.
* Schroeder B, Sanfillippo JS: [http://www.health.am/gyneco/chronic-pelvic-pain/ Chronic Pelvic Pain and Recurrent Abdominal Pain in Female Adolescents]. Pediatr Clin North Am 1999;46:566 - 567.
* Elisabeth Thibaud, Hyams JS: Clinical aspects of recurrent abdominal pain. [http://www.health.am/gyneco/pediatric-gynecology/ Pediatric and Adolescent Gynecology]Pediatr Ann 2001;30:17–21.
* Jantos M.: [http://www.pelviperineology.org/practical/chronic_pelvic_pain.html Understanding Chronic Pelvic Pain]. Pelviperineology Vol. 26 N.2 June 2007 66-68


===Males===
{{Main|Chronic prostatitis/chronic pelvic pain syndrome}}
In chronic pelvic pain, there are no standard diagnostic tests in males; diagnosis is by exclusion of other disease entities.<ref>{{Cite journal |last1=Zhang |first1=Jianzhong |last2=Liang |first2=ChaoZhao |last3=Shang |first3=Xuejun |last4=Li |first4=Hongjun |date=2020-01-31 |title=Chronic Prostatitis/Chronic Pelvic Pain Syndrome: A Disease or Symptom? Current Perspectives on Diagnosis, Treatment, and Prognosis |journal=American Journal of Men's Health |volume=14 |issue=1 |pages=1557988320903200 |doi=10.1177/1557988320903200 |issn=1557-9883 |pmc=7256330 |pmid=32005088}}</ref>


==Treatment==
== External links ==
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.<ref>{{cite book |vauthors=Ghanavatian S, Leslie SW, Derian A |title= Pudendal nerve block in StatPearls |chapter= Pudendal Nerve Block |date= May 30, 2023|pmid=31855362 |publisher=National Library of Medicine|url=https://www.ncbi.nlm.nih.gov/books/NBK551518/}}</ref>
* [http://www.pelvicpain.org International Pelvic Pain Society]
* [http://www.ampainsoc.org American Pain Society]
* [http://www2.med.umich.edu/departments/obgyn/index.cfm?fuseaction=Obgyn.pelvicPainClinic University of Michigan Pelvic Pain Program]
* [http://www.med.unc.edu/obgyn/services_algs.html University of North Carolina Pelvic Pain Program]
*[http://www.emedicine.com/pmr/topic242.htm Tailbone pain (coccyx pain, coccydynia): Free medical article online at eMedicine]
*[http://www.pelviperineology.org/ Pelviperineology] The multidisciplinary open access pelvic floor journal


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.<ref name="ReferenceA">{{Cite journal |last1=Capra |first1=P. |last2=Perugini |first2=P. |last3=Bleve |first3=M. |last4=Pavanetto |first4=P. |last5=Musitelli |first5=G. |last6=Rovereto |first6=B. |last7=Porru |first7=D. |date=2013 |title=Innovative Approach for Interstitial Cystitis: Vaginal Pessaries Loaded Diazepam—A Preliminary Study |journal=Journal of Pharmaceutics |volume=2013 |pages=386546 |doi=10.1155/2013/386546 |issn=2090-9918 |pmc=4590789 |pmid=26555976|doi-access=free }}</ref> 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)<ref>{{Cite journal |last1=Hunter |first1=Corey W. |last2=Stovall |first2=Brad |last3=Chen |first3=Grant |last4=Carlson |first4=Jonathan |last5=Levy |first5=Robert |date=March 2018 |title=Anatomy, Pathophysiology and Interventional Therapies for Chronic Pelvic Pain: A Review |journal=Pain Physician |volume=21 |issue=2 |pages=147–167 |doi=10.36076/ppj.2018.2.147 |issn=2150-1149 |pmid=29565946|doi-access=free }}</ref> leading to failures. Spinal cord stimulation aimed at the mid- to high-thoracic region of the spinal cord have produced some positive results.<ref>{{cite journal|last1=Hunter|first1=C|last2=Davé|first2=N|last3=Diwan|first3=S|last4=Deer|first4=T|title=Neuromodulation of pelvic visceral pain: review of the literature and case series of potential novel targets for treatment.|journal=Pain Practice|date=Jan 2013|volume=13|issue=1|pages=3–17|pmid=22521096|doi=10.1111/j.1533-2500.2012.00558.x|s2cid=39659746|doi-access=free}}</ref> 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.).<ref>{{Cite journal |last1=Hunter |first1=Corey W. |last2=Yang |first2=Ajax |date=January 2019 |title=Dorsal Root Ganglion Stimulation for Chronic Pelvic Pain: A Case Series and Technical Report on a Novel Lead Configuration |url=https://pubmed.ncbi.nlm.nih.gov/30067887/ |journal=Neuromodulation: Journal of the International Neuromodulation Society |volume=22 |issue=1 |pages=87–95 |doi=10.1111/ner.12801 |issn=1525-1403 |pmid=30067887|s2cid=51892311 }}</ref><ref>{{Cite journal |last1=Hunter |first1=Corey W. |last2=Falowski |first2=Steven |date=2021-02-03 |title=Neuromodulation in Treating Pelvic Pain |url=https://pubmed.ncbi.nlm.nih.gov/33534006/ |journal=Current Pain and Headache Reports |volume=25 |issue=2 |pages=9 |doi=10.1007/s11916-020-00927-y |issn=1534-3081 |pmid=33534006|s2cid=231787453 }}</ref>
[[Category:Gynecology]]
[[Category:Nociception]]
[[Category:Chronic pain syndromes]]


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. [[Diazepam]] ([[Valium]]) suppositories are an older therapy that was offered to patients with pelvic pain based on the belief that by delivering the medication in closer proximity to the area of pain that a greater effect would be gained.<ref name="ReferenceA"/> However, this hypothesis has been disproven due to the fact that [[benzodiazepine]]s work on the [[GABA receptor]] which is present within the central nervous system and do not work locally - therefore, regardless of the route of administration of the medication, it will still need to travel to the central nervous system to work so it is no more or less effective being given "closer" to the area of discomfort.<ref>{{Cite journal |last1=Griffin |first1=Charles E. |last2=Kaye |first2=Adam M. |last3=Bueno |first3=Franklin Rivera |last4=Kaye |first4=Alan D. |date=2013 |title=Benzodiazepine Pharmacology and Central Nervous System–Mediated Effects |journal=The Ochsner Journal |volume=13 |issue=2 |pages=214–223 |issn=1524-5012 |pmc=3684331 |pmid=23789008}}</ref> Moreover, benzodiazepines have not been shown to be effective for pelvic pain and should only be used with extreme caution due to the potential for addiction. Similarly, hydrodissection is another treatment that has been suggested for pelvic pain despite the fact that there is no evidence whatsoever to substantiate its use.<ref>{{Cite web |date=2021-03-23 |title=Hydrodissection - Science or Science Fiction |url=https://ainsworthinstitute.com/hydrodissection-science-or-science-fiction/ |access-date=2022-04-23 |website=Ainsworth Institute |language=en-US}}</ref> Proponents suggest the therapy is able to "move" adjacent tissue away from a potentially compressed nerve by injecting small amounts of fluid under ultrasound guidance; however this premise is incorrect due to the fact that [[in vivo]] tissue will nearly always absorb foreign fluid and return to its original orientation in a matter of minutes to days.
[[pl:Zespół bólowy miednicy mniejszej]]


[[Vibrator (sex toy)|Vibrators]] have also been found to be effective at addressing Pelvic Pain.<ref name="Rodriguez Martinez S103–S104">{{Cite journal |last1=Rodriguez Martinez |first1=JE |last2=López Martínez |first2=MC |last3=Martínez Mas |first3=J |last4=Conesa Peñalver |first4=MdlM |date=2022-04-01 |title=Preliminary Results From a Multicenter Study on the Use of a New Device for the Treatment of Genito Pelvic Pain Disorders |url=https://www.sciencedirect.com/science/article/pii/S1743609522002533 |journal=The Journal of Sexual Medicine |series=Proceedings of 22nd Annual Fall Scientific Meeting of SMSNA |language=en |volume=19 |issue=4, Supplement 1 |pages=S103–S104 |doi=10.1016/j.jsxm.2022.01.220 |issn=1743-6095}}</ref><ref>{{Cite journal |last1=Dubinskaya |first1=Alexandra |last2=Horwitz |first2=Rainey |last3=Shoureshi |first3=Poone |last4=Anger |first4=Jennifer |last5=Scott |first5=Victoria |last6=Eilber |first6=Karyn |title=Mp38-16 is It Time for FPMRS to Prescribe Vibrators? |date=May 2022 |url=http://www.auajournals.org/doi/10.1097/JU.0000000000002592.16 |journal=Journal of Urology |language=en |volume=207 |issue=Supplement 5 |doi=10.1097/JU.0000000000002592.16 |s2cid=248032489 |issn=0022-5347}}</ref> 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|MysteryVibe's]] Crescendo<ref name="Rodriguez Martinez S103–S104"/><ref>{{Cite web |title=Establishment Registration & Device Listing |url=https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfRL/rl.cfm?lid=660581&lpcd=KXQ |access-date=2023-07-18 |website=www.accessdata.fda.gov}}</ref><ref>{{Cite news |last=Geddes |first=Linda |date=2023-06-09 |title='Between pleasure and health': how sex-tech firms are reinventing the vibrator |language=en-GB |work=The Guardian |url=https://www.theguardian.com/society/2023/jun/09/how-sex-tech-firms-are-reinventing-the-vibrator |access-date=2023-07-18 |issn=0261-3077}}</ref> and Intimate Rose's Pelvic Wand.


===Females===
<!-- This is a long comment. This will now prevent the page coming up in special short pages. Thus allowing editors to find short pages that might need speedy deletion. Please do not remove this long comment, thank you-->
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.<ref name="pmid20177285">{{cite journal |vauthors=Kuppermann M, Learman LA, Schembri M, etal |title=Predictors of hysterectomy use and satisfaction |journal=Obstet Gynecol |volume=115 |issue=3 |pages=543–51 |date=March 2010 |pmid=20177285 |doi=10.1097/AOG.0b013e3181cf46a0 |s2cid=205472339 }}</ref>

===Males===
{{Main|Chronic_prostatitis/chronic_pelvic_pain_syndrome#Treatment|l1=Treatment of CP/CPPS}}

==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 [[dysmenorrhoea]] between 16.8 and 81%, [[dyspareunia]] between 8-21.8%, and noncyclical pain between 2.1 and 24%.<ref>{{cite journal |vauthors=Latthe P, Latthe M, Say L, Gülmezoglu M, Khan KS |title=WHO systematic review of prevalence of chronic pelvic pain: a neglected reproductive health morbidity |journal=BMC Public Health |volume=6 |page=177 |year=2006 |pmid=16824213 |pmc=1550236 |doi=10.1186/1471-2458-6-177 |doi-access=free }}</ref>

According to the [[Centers for Disease Control and Prevention|CDC]], Chronic pelvic pain (CPP) accounted for approximately 9% of all visits to gynecologists in 2007.<ref>{{cite news | last =Hsiao | first =Chun-Ju | title =National Ambulatory medical Care Survey: 2007 Summary | newspaper =National Health Statistics Report | publisher =Centers for Disease Control | date =3 November 2010 | url =https://www.cdc.gov/nchs/data/nhsr/nhsr027.pdf | access-date =1 September 2013 }}</ref> In addition, CPP is the reason for 20-30% of all laparoscopies in adults.<ref>{{Cite book|url=https://books.google.com/books?id=Bb6ZBAAAQBAJ&pg=PA261|title=Case Studies in Pain Management|last1=Kaye|first1=Alan David|last2=Shah|first2=Rinoo V.|date=2014-10-16|publisher=Cambridge University Press|isbn=9781107682894|language=en}}</ref> Pelvic girth pain is frequent during pregnancy.<ref name=HallCramer2016>{{cite journal|last1=Hall|first1=Helen|last2=Cramer|first2=Holger|last3=Sundberg|first3=Tobias|last4=Ward|first4=Lesley|last5=Adams|first5=Jon|last6=Moore|first6=Craig|last7=Sibbritt|first7=David|last8=Lauche|first8=Romy|title=The effectiveness of complementary manual therapies for pregnancy-related back and pelvic pain|journal=Medicine|volume=95|issue=38|year=2016|pages=e4723|doi=10.1097/MD.0000000000004723|pmc=5044890|pmid=27661020}}</ref>

==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.<ref name="Grace2000">{{cite journal |last=Grace |first=Victoria |author-link=Victoria Grace |year=2000 |title=Pitfalls of the medical paradigm in chronic pelvic pain |journal=Best Practice & Research. Clinical Obstetrics & Gynaecology |volume=14 |issue=3 |page=527 |doi=10.1053/beog.1999.0089 |pmid=10962640}}</ref> 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.<ref name=Grace2000/> 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.<ref name=Grace2000/> 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.<ref name=Grace2000/> 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.<ref name=Grace2000/>

==References==
{{Reflist}}

== External links ==
{{Medical resources
| DiseasesDB =
| ICD10 = {{ICD10|R|10|2|n|80}}
| ICD9 = {{ICD9|625.9}}, {{ICD9|789.00}}
| ICDO =
| OMIM =
| MedlinePlus =
| eMedicineSubj =
| eMedicineTopic =
| eMedicine_mult =
| MeshID = D017699
}}
* [http://www.emedicine.com/pmr/topic242.htm Tailbone pain (coccyx pain, coccydynia)]

{{Digestive system and abdomen symptoms and signs}}
{{Pain}}
{{Female diseases of the pelvis and genitals}}

{{DEFAULTSORT:Pelvic Pain}}
[[Category:Gynaecology]]
[[Category:Nociception]]
[[Category:Chronic pain syndromes]]
[[Category:Ailments of unknown cause]]

Latest revision as of 07:14, 8 May 2024

Pelvic and perineal pain
Micrograph showing endometriosis (H&E stain), a common cause of chronic pelvic pain in women.
Frequency43% worldwide[1]

Pelvic pain is pain in the area of the pelvis. Acute pain is more common than chronic pain.[2] If the pain lasts for more than six months, it is deemed to be chronic pelvic pain.[3][4] It can affect both the male and female pelvis.

Common causes in include: endometriosis in women, bowel adhesions, irritable bowel syndrome, and interstitial cystitis.[5][6] The cause may also be a number of poorly understood conditions that may represent abnormal psychoneuromuscular function.

The role of the nervous system in the genesis and moderation of pain is explored.[7] The importance of psychological factors is discussed, both as a primary cause of pain and as a factor which affects the pain experience. As with other chronic syndromes, the biopsychosocial model offers a way of integrating physical causes of pain with psychological and social factors.[8]

Terminology

[edit]

Pelvic pain is a general term that may have many causes, listed below.

The subcategorical term urologic chronic pelvic pain syndrome (UCPPS) is an umbrella term adopted for use in research into urologic pain syndromes associated with the male and female pelvis.[9] UCPPS specifically refers to chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) in men and interstitial cystitis or painful bladder syndrome (IC/PBS) in women.[10]

Cause

[edit]
Further information: List of causes of genital pain

Genital pain and pelvic pain can arise from a variety of conditions, crimes, trauma, medical treatments, physical diseases, mental illness and infections. In some instances the pain is consensual and self-induced. Self-induced pain can be a cause for concern and may require a psychiatric evaluation.

Female

[edit]

Many different conditions can cause female pelvic pain including:

Related to pregnancy
Gynecologic (from more common to less common)
Abdominal

Diagnosis

[edit]

Females

[edit]

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

[edit]
Main article: Chronic prostatitis/chronic pelvic pain syndrome

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

Treatment

[edit]

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. Diazepam (Valium) suppositories are an older therapy that was offered to patients with pelvic pain based on the belief that by delivering the medication in closer proximity to the area of pain that a greater effect would be gained.[18] However, this hypothesis has been disproven due to the fact that benzodiazepines work on the GABA receptor which is present within the central nervous system and do not work locally - therefore, regardless of the route of administration of the medication, it will still need to travel to the central nervous system to work so it is no more or less effective being given "closer" to the area of discomfort.[23] Moreover, benzodiazepines have not been shown to be effective for pelvic pain and should only be used with extreme caution due to the potential for addiction. Similarly, hydrodissection is another treatment that has been suggested for pelvic pain despite the fact that there is no evidence whatsoever to substantiate its use.[24] Proponents suggest the therapy is able to "move" adjacent tissue away from a potentially compressed nerve by injecting small amounts of fluid under ultrasound guidance; however this premise is incorrect due to the fact that in vivo tissue will nearly always absorb foreign fluid and return to its original orientation in a matter of minutes to days.

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

[edit]

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

[edit]
Main article: Treatment of CP/CPPS

Epidemiology

[edit]

Female

[edit]

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 dysmenorrhoea between 16.8 and 81%, dyspareunia between 8-21.8%, and noncyclical pain between 2.1 and 24%.[30]

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

[edit]

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

[edit]
  1. ^ Brown, CL; Rizer, M; Alexander, R; Sharpe EE, 3rd; Rochon, PJ (March 2018). "Pelvic Congestion Syndrome: Systematic Review of Treatment Success". Seminars in Interventional Radiology. 35 (1): 35–40. doi:10.1055/s-0038-1636519. PMC 5886772. PMID 29628614.{{cite journal}}: CS1 maint: numeric names: authors list (link)
  2. ^ "Acute Pain vs. Chronic Pain: Differences & Causes". Cleveland Clinic. Retrieved 2022-04-23.
  3. ^ Dydyk, Alexander M.; Gupta, Nishant (2022), "Chronic Pelvic Pain", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID 32119472, retrieved 2022-04-23
  4. ^ "Chronic pelvic pain" (PDF). ACOG. Retrieved 11 June 2014.
  5. ^ Moore, Jane; Kennedy, Stephen (2000-06-01). "Causes of chronic pelvic pain". Best Practice & Research Clinical Obstetrics & Gynaecology. 14 (3): 389–402. doi:10.1053/beog.1999.0082. ISSN 1521-6934. PMID 10962633.
  6. ^ Ortiz, DD (Jun 1, 2008). "Chronic pelvic pain in women". American Family Physician. 77 (11): 1535–42. PMID 18581833.
  7. ^ Moore, J.; Kennedy, S. (June 2000). "Causes of chronic pelvic pain". Baillière's Best Practice & Research. Clinical Obstetrics & Gynaecology. 14 (3): 389–402. doi:10.1053/beog.1999.0082. PMID 10962633.
  8. ^ Meints, S.M.; Edwards, R.R. (2018-12-20). "Evaluating Psychosocial Contributions to Chronic Pain Outcomes". Progress in Neuro-psychopharmacology & Biological Psychiatry. 87 (Pt B): 168–182. doi:10.1016/j.pnpbp.2018.01.017. ISSN 0278-5846. PMC 6067990. PMID 29408484.
  9. ^ Clemens, J. Quentin; Mullins, Chris; Ackerman, A. Lenore; Bavendam, Tamara; van Bokhoven, Adrie; Ellingson, Benjamin M.; Harte, Steven E.; Kutch, Jason J.; Lai, H. Henry; Martucci, Katherine T.; Moldwin, Robert (March 2019). "Urologic chronic pelvic pain syndrome: insights from the MAPP Research Network". Nature Reviews. Urology. 16 (3): 187–200. doi:10.1038/s41585-018-0135-5. ISSN 1759-4820. PMC 6800057. PMID 30560936.
  10. ^ Adamian L, Urits I, Orhurhu V, Hoyt D, Driessen R, Freeman JA, Kaye AD, Kaye RJ, Garcia AJ, Cornett EM, Viswanath O (May 2020). "A Comprehensive Review of the Diagnosis, Treatment, and Management of Urologic Chronic Pelvic Pain Syndrome". Curr Pain Headache Rep. 24 (6): 27. doi:10.1007/s11916-020-00857-9. PMID 32378039. S2CID 218513050.
  11. ^ "Ectopic Pregnancy: Symptoms, Causes, Treatments & Tests". Cleveland Clinic. Retrieved 2022-04-23.
  12. ^ Janssen, E. B.; Rijkers, A. C. M.; Hoppenbrouwers, K.; Meuleman, C.; d'Hooghe, T. M. (2013). "Prevalence of endometriosis diagnosed by laparoscopy in adolescents with dysmenorrhea or chronic pelvic pain: A systematic review". Human Reproduction Update. 19 (5): 570–582. doi:10.1093/humupd/dmt016. PMID 23727940.
  13. ^ "Pelvic inflammatory disease (PID) - Symptoms and causes". Mayo Clinic. Retrieved 2022-04-23.
  14. ^ Institute of Medicine (US) Committee on Advancing Pain Research, Care (2011). Introduction. National Academies Press (US).
  15. ^ Golanska, Paulina; Saczuk, Klara; Domarecka, Monika; Kuć, Joanna; Lukomska-Szymanska, Monika (2021-07-23). "Temporomandibular Myofascial Pain Syndrome—Aetiology and Biopsychosocial Modulation. A Narrative Review". International Journal of Environmental Research and Public Health. 18 (15): 7807. doi:10.3390/ijerph18157807. ISSN 1661-7827. PMC 8345811. PMID 34360099.
  16. ^ Zhang, Jianzhong; Liang, ChaoZhao; Shang, Xuejun; Li, Hongjun (2020-01-31). "Chronic Prostatitis/Chronic Pelvic Pain Syndrome: A Disease or Symptom? Current Perspectives on Diagnosis, Treatment, and Prognosis". American Journal of Men's Health. 14 (1): 1557988320903200. doi:10.1177/1557988320903200. ISSN 1557-9883. PMC 7256330. PMID 32005088.
  17. ^ Ghanavatian S, Leslie SW, Derian A (May 30, 2023). "Pudendal Nerve Block". Pudendal nerve block in StatPearls. National Library of Medicine. PMID 31855362.
  18. ^ a b Capra, P.; Perugini, P.; Bleve, M.; Pavanetto, P.; Musitelli, G.; Rovereto, B.; Porru, D. (2013). "Innovative Approach for Interstitial Cystitis: Vaginal Pessaries Loaded Diazepam—A Preliminary Study". Journal of Pharmaceutics. 2013: 386546. doi:10.1155/2013/386546. ISSN 2090-9918. PMC 4590789. PMID 26555976.
  19. ^ Hunter, Corey W.; Stovall, Brad; Chen, Grant; Carlson, Jonathan; Levy, Robert (March 2018). "Anatomy, Pathophysiology and Interventional Therapies for Chronic Pelvic Pain: A Review". Pain Physician. 21 (2): 147–167. doi:10.36076/ppj.2018.2.147. ISSN 2150-1149. PMID 29565946.
  20. ^ Hunter, C; Davé, N; Diwan, S; Deer, T (Jan 2013). "Neuromodulation of pelvic visceral pain: review of the literature and case series of potential novel targets for treatment". Pain Practice. 13 (1): 3–17. doi:10.1111/j.1533-2500.2012.00558.x. PMID 22521096. S2CID 39659746.
  21. ^ Hunter, Corey W.; Yang, Ajax (January 2019). "Dorsal Root Ganglion Stimulation for Chronic Pelvic Pain: A Case Series and Technical Report on a Novel Lead Configuration". Neuromodulation: Journal of the International Neuromodulation Society. 22 (1): 87–95. doi:10.1111/ner.12801. ISSN 1525-1403. PMID 30067887. S2CID 51892311.
  22. ^ Hunter, Corey W.; Falowski, Steven (2021-02-03). "Neuromodulation in Treating Pelvic Pain". Current Pain and Headache Reports. 25 (2): 9. doi:10.1007/s11916-020-00927-y. ISSN 1534-3081. PMID 33534006. S2CID 231787453.
  23. ^ Griffin, Charles E.; Kaye, Adam M.; Bueno, Franklin Rivera; Kaye, Alan D. (2013). "Benzodiazepine Pharmacology and Central Nervous System–Mediated Effects". The Ochsner Journal. 13 (2): 214–223. ISSN 1524-5012. PMC 3684331. PMID 23789008.
  24. ^ "Hydrodissection - Science or Science Fiction". Ainsworth Institute. 2021-03-23. Retrieved 2022-04-23.
  25. ^ a b Rodriguez Martinez, JE; López Martínez, MC; Martínez Mas, J; Conesa Peñalver, MdlM (2022-04-01). "Preliminary Results From a Multicenter Study on the Use of a New Device for the Treatment of Genito Pelvic Pain Disorders". The Journal of Sexual Medicine. Proceedings of 22nd Annual Fall Scientific Meeting of SMSNA. 19 (4, Supplement 1): S103–S104. doi:10.1016/j.jsxm.2022.01.220. ISSN 1743-6095.
  26. ^ Dubinskaya, Alexandra; Horwitz, Rainey; Shoureshi, Poone; Anger, Jennifer; Scott, Victoria; Eilber, Karyn (May 2022). "Mp38-16 is It Time for FPMRS to Prescribe Vibrators?". Journal of Urology. 207 (Supplement 5). doi:10.1097/JU.0000000000002592.16. ISSN 0022-5347. S2CID 248032489.
  27. ^ "Establishment Registration & Device Listing". www.accessdata.fda.gov. Retrieved 2023-07-18.
  28. ^ Geddes, Linda (2023-06-09). "'Between pleasure and health': how sex-tech firms are reinventing the vibrator". The Guardian. ISSN 0261-3077. Retrieved 2023-07-18.
  29. ^ Kuppermann M, Learman LA, Schembri M, et al. (March 2010). "Predictors of hysterectomy use and satisfaction". Obstet Gynecol. 115 (3): 543–51. doi:10.1097/AOG.0b013e3181cf46a0. PMID 20177285. S2CID 205472339.
  30. ^ Latthe P, Latthe M, Say L, Gülmezoglu M, Khan KS (2006). "WHO systematic review of prevalence of chronic pelvic pain: a neglected reproductive health morbidity". BMC Public Health. 6: 177. doi:10.1186/1471-2458-6-177. PMC 1550236. PMID 16824213.
  31. ^ Hsiao, Chun-Ju (3 November 2010). "National Ambulatory medical Care Survey: 2007 Summary" (PDF). National Health Statistics Report. Centers for Disease Control. Retrieved 1 September 2013.
  32. ^ Kaye, Alan David; Shah, Rinoo V. (2014-10-16). Case Studies in Pain Management. Cambridge University Press. ISBN 9781107682894.
  33. ^ Hall, Helen; Cramer, Holger; Sundberg, Tobias; Ward, Lesley; Adams, Jon; Moore, Craig; Sibbritt, David; Lauche, Romy (2016). "The effectiveness of complementary manual therapies for pregnancy-related back and pelvic pain". Medicine. 95 (38): e4723. doi:10.1097/MD.0000000000004723. PMC 5044890. PMID 27661020.
  34. ^ a b c d e Grace, Victoria (2000). "Pitfalls of the medical paradigm in chronic pelvic pain". Best Practice & Research. Clinical Obstetrics & Gynaecology. 14 (3): 527. doi:10.1053/beog.1999.0089. PMID 10962640.
[edit]
Retrieved from "https://en.wikipedia.org/w/index.php?title=Pelvic_pain&oldid=1222843832"