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Chronic pelvic pain lasting over six months and not related to menstrual cycle is a condition experienced by women, and there are numerous causes, including gynecologic, urologic, gastrointestinal, musculoskeletal, neurologic, and psychological factors. Women who have suffered sexual, physical, or emotional trauma are at a higher risk of developing chronic pelvic pain, and they also have higher rates of psychological disorders than their peers. Men, on the other hand, commonly experience chronic pelvic pain due to chronic prostatitis and may also have psychological disorders. There are various treatment options, such as surgery, medication, and nonpharmacological therapies, including alternative therapies. Cognitive-behavioral therapy is an additional treatment option that should be considered when treating chronic pelvic pain syndrome.
A 38-year-old female, gravida 2, para 2, presents with pelvic pain for several years. Pain is localized to the bilateral lower abdomen and pelvis. She describes it as dull, achy, constant, and of mild intensity. Pain occurs most days and is unrelated to menses. She has been reading on the internet that hysteroscopic sterilization devices have been removed from the market and she is concerned that her implants may be causing her symptoms. She reports fatigue but no nausea, vomiting, diarrhea, constipation, irregular bleeding, vaginal discharge, or bladder symptoms. She has no past medical history. Her surgical history is significant for Essure hysteroscopic sterilization 5 years ago. She is not taking any medication and has no known allergies.
A 35-year-old nulligravid woman is scheduled to undergo diagnostic laparoscopy for evaluation of chronic pelvic pain. She describes her pain as sharp and stabbing that does wax and wane throughout the month but is always present. It is located in the pelvis and does not seem to be affected by bowel or bladder function. Her medical history is significant for ulcerative colitis and endometriosis. Her surgical history is significant for laparoscopic cholecystectomy, coloproctectomy with ileo J pouch creation, laparoscopic ablation of endometriosis, and total laparoscopic hysterectomy. Her coloproctectomy was complicated by postoperative peritonitis that necessitated a prolonged course of intravenous antibiotics. She is not currently on any medications and has no known allergies.
Adenomyosis is a common disorder in the gynecologic population that consists of the presence of endometrial glands and stroma in the myometrium. Adenomyosis is associated with chronic pelvic pain, dysmenorrhea, dyspareunia, and feelings of pressure low in the pelvis due to uterine enlargement. Infection of the pelvis causes pain by several different mechanisms: pelvic inflammatory disease, puerperal infections, postoperative gynecologic surgery, and abortion-related infections. Pelvic congestion syndrome (PCS) is a pelvic pain syndrome caused by retrograde flow in an incompetent ovarian vein. Symptoms associated with PCS include a shifting location of pain, deep dyspareunia, and postcoital pain, with exacerbation of symptoms after prolonged standing. Ultrasound is a very useful tool for evaluating chronic pelvic pain sufferers. Patients have better satisfaction due to their understanding of their pain, with a goal of better productivity and return to normal function.
This chapter presents the definition, risk factors, symptoms, diagnosis and treatment of chronic pelvic pain (CPP), dysmenorrhea, and dyspareunia. The most common causes of CPP are gastrointestinal. Irritable bowel syndrome (IBS), constipation, and diverticulitis, all can cause chronic pelvic pain. Women with high stress levels have two times the risk of dysmenorrhea. A higher risk of suffering dysmenorrhea occurs in women who are overweight. Women with dyspareunia had higher pain scores and higher levels of psychological distress, low levels of marital adjustment and more problems with sexual function. Treatment of dyspareunia is based on one of the three types: insertional dyspareunia, pain in a specific location, and pain with deep penetration. Pain associated with menopausal disorders and sexual relations is common and often the presenting complaint to the physician. The case of dyspareunia may be difficult to discover but an organized approach including psychological expectations may produce improvement.
This chapter provides an overview of the contribution of ultrasound examination to the evaluation of gynaecological conditions. Ultrasound imaging can be used to assess women with a history of acute or chronic pelvic pain. The imaging allows a quick non-invasive assessment of the pelvis and abdomen and it may be used as the first line investigation of patients with pelvic pain to confirm or exclude the provisional diagnosis based on clinical history. Ultrasound imaging determines the extent of ovarian and adnexal involvement in women with pelvic inflammatory disease. Ultrasound is helpful in assessing women with a history of post-menopausal bleeding and it can distinguish between women with post-menopausal bleeding who need to undergo invasive testing from those who do not require any intervention. Ultrasound is used to determine both the pregnancy location and viability. Transvaginal ultrasound has an important role in the study of female fertility.
This chapter focuses on the use of laparoscopy in treatment and diagnosis of patients with pelvic pain, adnexal masses, and pelvic inflammatory disease (PID). A discussion of incidental appendectomy in these patients will also be presented. The decision to perform incidental appendectomy is based on the premise that the appendix is a vestigial, functionless organ, with the potential only to contribute to pathological change. PID can have devastating consequences to adolescent females. With the advent of in vitro fertilization, surgeons should attempt to perform the most conservative surgery that is safely possible, in order to maintain the option of future childbearing. Diagnosis of endometriosis should not be delayed in adolescents. A delay may not only postpone symptomatic relief but also worsen the patient's future fertility and allow the disease to progress. Laparoscopy, as it applies to the pediatric and adolescent population, is a relative newcomer to the field.
This chapter describes major research directions in the study of each of the nine functional somatic syndromes and highlights the overlapping dimensions. The fact that a substantial proportion of chronic fatigue syndrome (CFS) patients have concurrent symptoms sufficient for a diagnosis of major depression has prompted the investigation of the serotonin function with the new method of d-fenfluramine challenge. A genetic factor responsible for the family aggregation of fibromyalgia has been demonstrated among patients attending the rheumatology clinic of the University Hospital, Beer Sheva, Israel. The presence of chronic pelvic pain in patients with irritable bowel was associated with a significantly higher likelihood of childhood sexual abuse, panic disorder and a lifetime history of somatization disorder. A prominent biological abnormality of patients with premenstrual syndrome is serotonergic deficiency. There is substantial evidence that mast cell activation plays an important role in the production of abnormalities associated with interstitial cystitis (IC).
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