Common Causes of Chronic Pelvic Pain Diagnoses Description Dysmenorrhea • Dysmenorrhea is pain during menstruation that is not associated with well-defined pathology. • Primary dysmenorrhea: cramping pain in the lower abdomen, originating in the uterus • Secondary dysmenorrhea: painful menstruation resulting from pelvic pathology such as endometriosis • Dysmenorrhea is considered a chronic pain syndrome if it is persistent and associated with negative cognitive, behavioral, sexual or emotional consequences. Dyspareunia • Dyspareunia is characterized as pain before, during, or after sexual activity. It is not solely caused by lack of lubrication. • Dyspareunia may present as superficial, deep, or both. • Superficial: discomfort at entry of vaginal introitus • Deep: complaint of pain or discomfort on deeper penetration • Causes of dyspareunia include atrophic vaginitis, vulvar vestibulitis, lichen sclerosis, endometriosis, scar adhesions, and trauma. Endometriosis • Endometriosis is when endometrial tissue typically found in the uterus is found outside of the uterus. • Most women with endometriosis experience pelvic pain during their menstrual cycles but many also have pain that is unrelated to their period. Fibromyalgia syndrome • Fibromyalgia affects the muscles, tendons, ligaments, and soft tissues of the body. • Fibromyalgia causes pain throughout entire body, including the vulvar and pelvic/hip region. • Symptoms of fibromyalgia include extreme fatigue, sleep disturbances, burning sensations throughout body. Interstitial cystitis/ • Interstitial cystitis is characterized by: painful bladder syndrome o Urinary urgency: feeling the need to urinate o Urinary frequency: urinating up to every 5-10 minutes o Pelvic Pain: in the vulva, pain with intercourse, or pain in the lower back and hips. • Many foods and drinks may trigger interstitial cystitis. Fruit juices such as oranges, cranberry and tomato are bladder irritants. Caffeine stimulates bladder nerves, causing pain, inflammation and irritation of the bladder. Additionally, nerve stimulation produces urinary frequency. Pudendal Neuralgia • Neuralgia is a pain in the distribution of a nerve • Pudendal nerve is formed primarily by S2-S4. It branches into rectal, perineal, and dorsal nerve • Pain will be in the region of the three branches • May be exacerbated by sitting • There will not be sensory deficits (this would be associated with neuropathy) • Bowl, bladder, sexual dysfunction Vaginismus • Vaginismus is the involuntary clenching of the pelvic muscles that surround the outer third of the vagina, specifically the perineal and levator ani muscles. • Vaginismus can cause pain in the hips, lower back, and gluteal muscles during or after sex. Vulvodynia • Vulvodynia is an umbrella term used to describe idiopathic pelvic pain lasting at least three months. • The pain can be intermittent or constant and may be generalized, localized, or mixed. Pain is often worse at night and right before periods. Other Adhesions/scar tissue • Adhesions are areas of fibrous scar tissue. Adhesions are part of a normal healing process but for some can lead to pain. • Adhesions pain may result from surgeries including c-sections, myomectomy, hysterectomy, laparoscopic procedures, episiotomy, vestibulectomy, hymenotomy, perineal tear, or vulvar biopsies. • Adhesion pain may also result from endometriosis, previous abdominal surgery, or infection, such as appendicitis. Trauma • The chronic pelvic pain population has estimated 48-56% history of abuse • This does not only include sexual trauma, it is important to consider other events that individuals may not consider as a trauma such as a laborious birth Herman & Wallace (2020, March). Pelvic Pain Specific Diagnoses. In Kimberly Glow. Pelvic Floor Function, Dysfunction and Treatment (Level 1). Lecture conducted from Princeton, NJ. .