Chronic Pelvic and Urogenital Pain Syndromes

Cancer Pain Chronic pelvic and urogenital pain is a common and debilitating problem that has a significant impact on the quality of life of patients. These types of pain are some of the most common presenting symptoms for primary care doctors and fall within the practice of most medical specialties, but particularly urology, gynecology, and gastroenterology. Many urological, gastrointestinal, and gynecological disorders appear to cause or are associated with chronic pelvic pain, which often produces a diagnostic dilemma. Pain localized to the lower abdomen and the pelvic and perineal region can be a warning sign of acute or chronic tissue injury to the abdominal and pelvic organs, or it can be a chronic condition without identifiable pathology. Although patients seek medical care because they are looking for help to alleviate their pelvic discomfort and pain, in clinical practice much emphasis has been placed on finding a specific etiology and specific pathological markers for pelvic disease. These patients typically undergo many diagnostic tests and procedures. However, often the examination and workup remain unrevealing, and no specific cause of the pain can be identified. Many health care providers question the existence of chronic pelvic and urogenital pain, especially if the diagnostic workup does not reveal any pathology to explain the pain complaint. In these cases, it is important to recognize that pain is not simply a symptom of pelvic or urogenital disease, but that the patient is suffering from chronic pain, where pain is the prominent symptom of a chronic visceral pain syndrome. In addition, pain complaints localized to areas that are related to sexual function, defecation, and urination are often considered taboo and are complicated by psychological and unique physiological issues. Falvey has proposed that health care providers who work with patients with chronic pelvic pain make a conceptual shift in relation to the emotional aspects of chronic pelvic pain and consider the psychological disturbances as a result of the disease rather than the cause.