Chronic Pelvic Pain Mechanisms

Chronic Pelvic Pain

• Pain in chronic pelvic pain does not necessarily correlate to the pathologic extent of the disease.

Mechanisms of Pain

• Distension of ectopic endometrial glands within a closed space contributes to pain.
• Release of inflammatory mediators, such as prostaglandins or cytokines, causes pain.
• Involvement and irritation of pelvic nerves within adhesions lead to pain.

Types of Pain

• Dysmenorrhea:
  • Starts a few days before menstruation due to congestion.
  • Pain increases in severity during menstruation in a crescendo fashion.
  • Pain gradually decreases after menstruation due to absorption of blood.

Other Types of Pain

• Deep dyspareunia:
  • Caused by a fixed retroverted uterus or lesions in the pouch of Douglas or rectovaginal septum.
• Deep chronic pelvic pain:
  • Unresolving pain that lasts for more than 6 months.
• Dorsal (Sacral) pain:
  • Caused by affection of uterosacral ligaments, resulting in backache.
• Dysuria:
  • Painful urination.
• Dyschezia:
  • Painful defecation.