Chronic pelvic pain is defined as noncyclic pain lasting at least 6 months that localizes to the pelvis, lower abdomen, or lower back. It can be caused by visceral, parietal, or referred pain and may have nociceptive or neuropathic characteristics. Evaluation involves assessing onset, relationship to menstruation, character, location, severity, and associated symptoms. Causes include residual or remnant ovarian tissue remaining after hysterectomy, which can cause pain and dyspareunia. Neuropathic pain results from damage to the somatosensory nervous system and may involve abnormal sensations or pain from non-painful stimuli. Diagnosis involves laparoscopy and histopathology to identify potential causes.

1. Chronic pelvic pain
Undergraduate
Dr/ Ahmed Walid Anwar Morad
Assistant professor of OB/GYN
Benha University
2017

3. PHYSIOLOGY OF PAIN
Pelvic pain may be either :
1. Visceral ( Splanchnic) pain
2. Parietal (Somatic) pain
3. Referred pain
Pelvic pain may be either :
• Noceptive or
• Neuropathic.

4. Pelvic pain
• Acute pelvic pain:
– Located in the anatomic pelvis
– Short duration
– Sudden onset
• Chronic pelvic pain ?

5. Chronic pelvic pain
definition
• Character: noncyclic pain
• Duration: 6 or more months'
• Site: localizes to the anatomic pelvis, the
anterior abdominal wall at or below the
umbilicus, the lumbosacral back, or the
buttocks.
• Impact: severe to cause functional disability or
lead to medical care.
• ??? Cyclic, not related to menstruation, or
pregnancy.

9. Causes of chronic pelvic pain
Psychological causes should be considered only after exclusion of
organic causes.

11. Evaluation of CPP
A. Important clinical factors include:
– Onset.
– Relationship to the menstrual cycle (Is the pain
constant or does it vary?)
– Character.
– Location .
– Severity (Does it interfere with activities of daily life?)
– Presence of associated symptoms (e.g.,
dysmenorrhea and deep dyspareunia).
– Any other symptoms, such as fever, chills, nausea,
vomiting, or anorexia, should also be noted.

15. Treatment

16. Diagnosis: infertility+ pain+ laparoscopy+
histopathology

21. • Residual ovary syndrome
– Def: symptoms from ovaries that are left at
time of hysterectomy.
– Symptoms:
• Commonest : CPP & Dyspareunia
• Less common: asymptomatic pelvic mass.
• Remnant ovary syndrome
– Def: symptoms from ovarian tissuescould not
removed at time of hysterectomy due to adhesion
or malignancy.
– Symptoms: CPP ,Dyspareunia & pelvic mass
– Investigations: premenopusal FSH, US, CT
– TTT: Excision.

22. • Neuropathic pain is pain caused by damage or
disease affecting the somatosensory nervous system.
[1] Neuropathic pain may be associated with
abnormal sensations called dysesthesia or pain from
normally non-painful stimuli (allodynia).
• Neuropathic pain may result from disorders of the
peripheral nervous system or the central nervous
system (brain and spinal cord). Thus, neuropathic
pain may be divided into peripheral neuropathic pain,
central neuropathic pain, or mixed (peripheral and
central) neuropathic pain.

23. Thank You
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