The cause of chronic intermittent or chronic constant pelvic pain for a particular woman depends on (1) the presence of abnormal or damaged tissue that signals pain, and (2) the individual woman's modulation or modification of this pain signal.
The evaluation of a patient with pain should involve a careful assessment of symptoms and signs that are suggestive of specific diseases. Theses "clues" can help to focus further testing and treatment.
A symptom is an abnormality in function, appearance, or sensation that is experienced by a patient and is indicative of disease. For example, symptoms of a heart attack might include weakness, confusion, difficulty catching your breath, and chest pain.
A sign is an abnormality in function, appearance or sensation that is discoverable by a physician during the examination of a patient and is indicative of disease. A sign is often referred to as an objective symptom. For example, signs of a heart attack might include altered coordination, a change in mental status, shortness of breath and abnormalities in blood work.
When a woman has pain for a long time, usually thought to be greater than 3-4 months, then she may undergo a change in the way that she "filters" or modulates this pain signal. On a physiological level, a popular model postulates that there is a spinal cord system that acts as a "gate" to process and integrate the complex array of signals that it receives from the body and that this "gate" may use both physical and psychological variables (like the co-existence of depression) to modify how pain is experienced. On a cognitive or psychological level, it is often believed that an individual patient's "gate" may become further "conditioned" by the responses of others, which may effectively result in positive reinforcements (such as personal attention or financial reward) or negative reinforcements (such as loss of employment or scorn). On a highly personal level, a patient's unique character, her attitudes about adult sexuality, co-morbidity with depression, and a history of prior sexual abuse (especially childhood sexual abuse) have all been proposed as having a significant impact on how pelvic pain is processed and dealt with.
The ways in which women modify pelvic pain signals are important, especially when these modifications become persistent and develop into an independent problem, such as the chronic pain syndrome. Common diagnostic criteria for the chronic pain syndrome include
- a duration of greater than 4-6 months,
- failure of prior treatments to provide significant relief,
- deterioration of function at home and/or at work, and
- evidence of depression (sleep disturbances, loss of appetite, weight loss)
Evaluation and coordination of treatment with a psychologist or psychiatrist is often very helpful in dealing with the chronic pain syndrome.
The types of abnormal or damaged tissues that can result in pelvic pain are reviewed here. These are separated into reproductive system, gastrointestinal system, urinary system, and musculoskeletal system.