Chronic pelvic pain
More details
Hide details
3rd Department of Gynecology, Medical University, Lublin, Poland
Corresponding author
Slawomir Wozniak   

3rd Department of Gynecology, Medical University, Lublin, Poland
Ann Agric Environ Med. 2016;23(2):223-226
Chronic pelvic pain (CPP) affects about 10–40% of women presenting to a physician, and is characterised by pain within the minor pelvis persisting for over 6 months.

Material and Methods:
The Medline database was searched using the key words ‘chronic pelvic pain’ and ‘pelvic congestion syndrome’, published in English during the past 15 years. The condition markedly deteriorates the quality of life of the affected. Its aetiology has not been fully described and elucidated, although organic, functional and psychosomatic factors are implicated. Pain associated with parametrial varices was defined as pelvis congestion syndrome (PCS). Since the aetiology of CPP is complex, multi-directional diagnostic procedures are required.

The main diagnostic methods employed are imaging examinations (ultrasound, computer tomography, magnetic resonance). Advances in interventional radiology considerably contributed to the CPP treatment. Currently, embolization of parametrial vessels is one of the most effective methods to relieve pain associated with pelvic congestion syndrome.

Due to the complex aetiology of chronic pelvic pain, the most beneficial effects are obtained when the therapy is based on cooperation of the gynaecologist, physiotherapist, psychologist and interventional radiologist.

Zondervan KT, Yudkin PL, Vessey MP. The community prevalence of chronic pelvic pain in women and associated illness behaviour. Br J Gen Pract. 2001; 51: 541–7.
Triolo O, Laganà AS, Sturlese E. Chronic pelvic pain in endometriosis: an overview. J Clin Med Res. 2013; 5: 153–63.
Perry CP. Current concepts of pelvic congestion and chronic pelvic pain. JSLS. 2001; 5: 105–110.
Gelbaya TA, El-Halwagy HE. Focus on primary care: chronic pelvic pain in women. Obstet Gynecol Surv. 2001; 56: 757–764.
Malykhina AP. Neural mechanisms of pelvic organ cross-sensitization. Neuroscience. 2007; 149: 660–672.
Wesselmann U. Neurogenic inflammation and chronic pelvic pain. World J Urol. 2001; 19: 180–185.
Royal College of Obstetricians and Gynaecologists: Development of RCOG Green-top Guidelines: The initial management of chronic pelvic pain. No. 41. London: RCOG; 2012.
Neis KJ, Neis F. Chronic pelvic pain: cause, diagnosis and therapy from a gynaecologist’s and an endoscopist’s point of view. Gynecol Endocrinol. 2009; 25: 757–761.
Revised American Society for Reproductive Medicine classification of endometriosis: 1996. Fertil Steril. 1997; 67: 817–821.
Randall GW, Gantt PA, Poe-Zeigler RL, [et al.]. Serum antiendometrial antibodies and diagnosis of endometriosis. Am J Reprod Immunol. 2007; 58: 374- 382.
Berkley KJ, Rapkin AJ, Papka RE. The pains of endometriosis. Science. 2005; 308: 1587–1589.
Raab S, Plate KH. Different networks, common growth factors: shared growth factors and receptors of the vascular and the nervous system. Acta Neuropathol. 2007; 113: 607–626.
Bedaiwy MA, Falcone T, Goldberg JM. Peritoneal fluid leptin is associated with chronic pelvic pain but not infertility in endometriosis patients. Hum Reprod. 2006; 21: 788–791.
Laganà AS, Salmeri FM, Retto G. Stage-related changes of peritoneal soluble TNFα and TNFR1 and TNFR2 in cells recovered from peritoneal fluid of women with endometriosis. J Reprod Immunol. 2012; 94: 94–95.
Dawood MY, Khan-Dawood FS, Wilson L. Peritoneal fluid prostaglandins and prostanoids in women with endometriosis, chronic pelvic inflammatory disease, and pelvic pain. Am J Obstet Gynecol. 1984; 148: 391–395.
Drosdzol-Cop A, Skrzypulec-Plinta V, Stojko R. Serum and peritoneal fluid immunological markers in adolescent girls with chronic pelvic pain. Obstet Gynecol Surv. 2012; 67: 374–381.
Taylor HC Jr. Vascular congestion and hyperemia; their effect on function in the female reproductive organs; clinical aspects of the congestion fibrosis syndrome. Am J Obstet Gynecol. 1949; 57: 637–653.
Metzger DA. Pelvic congestion. In: Steege JF, Metzger DA, Levy BS. Chronic Pelvic Pain: An Integrated Approach. Philadelphia: WB Saunders Co, 1999, 149–160.
Kaufman JA. Inferior vena cava and tributaries. In: Kaufman JA, Michael JL, eds. The Requisites: Vascular and Interventional Radiology. Philadelphia, PA: Mosby, 2004, 273–273.
Perry CP. Current concepts of pelvic congestion and chronic pelvic pain. JSLS. 2001; 5: 105–111.
Freedman J, Ganeshan A, Crowe PM. Pelvic congestion syndrome: the role of interventional radiology in the treatment of chronic pelvic pain. Postgrad Med J. 2010; 86: 704–710.
Park SJ, Lim JW, Ko YT. Diagnosis of pelvic congestion syndrome using transabdominal and transvaginal sonography. AJR Am J Roentgenol. 2004; 182: 683–688.
Rhodin A. Successful management of chronic pelvic pain. J Pain Palliat Care Pharmacother. 2013; 27: 289–291.
Jarrell JF, Vilos GA, Allaire C. Chronic Pelvic Pain Working Group; SOGC Consensus Guidelines for the Management of Chronic Pelvic Pain. J Obstet Gynaecol Can. 2005; 27: 781–801.
Brown J, Kives S, Akhtar M. Progestagens and anti-progestagens for pain associated with endometriosis. Cochrane Database of Systematic Reviews 2012; (3): CD002122.
Selak V, Farquhar C, Prentice A, Singla A. Danazol for pelvic pain associated with endometriosis. Cochrane Database Syst Rev. 2007: (4): CD000068.
Edwards RD, Robertson IR, MacLean AB, [et al.]. Case report: pelvic pain syndrome successful treatment of a case by ovarian veinembolisation. Clin Radiol. 1993; 47: 429–431.
Kim HS, Malhotra AD, Rowe PC. Embolotherapy for pelvic congestion syndrome: long-term results. J Vasc Interv Radiol. 2006; 17: 289–297.
Howard FM. Chronic pelvic pain in women. Am J Manag Care. 2001; 7: 1001–111.
Latthe P, Latthe M, Say L, Gulmezoglu M, Khan KS. WHO systematic review of prevalence of chronic pelvic pain: a neglected reproductive health morbidity. BMC Public Health 2006; 6: 177.
Latthe P, Mignini L, Gray R, Hills RK, Khan KS. Factors predisposing women to chronic pelvic pain: systematic review. BMJ 2006; 332: 749–55.
Cheong YC, Smotra G, Farquhar C. Non surgical interventions for the management of chronic pelvic pain. Cochrane Database of Systematic Reviews 2010; (11) CD008797.
Stones W, Cheong YC, Howard FM, Singh S. Interventions for treating chronic pelvic pain in women. Cochrane Database of Systematic Reviews 2005; (2) CD000387.
Journals System - logo
Scroll to top