Chronic Female Pelvic Pain—Part 2: Differential Diagnosis and Management

Abstract

Pelvic pain is a common condition. Treatment interventions have traditionally targeted biomedical conditions with variable success. Utilizing a systematic approach to examination of the pelvic girdle and related organ systems contained within the pelvis will aid the clinician in identifying the painful structure(s) as well as the associated impairments limiting functional recovery. From this, a complete management program can be instituted. The following description of gynecologic, urologic, gastrointestinal, musculoskeletal, and neurologic conditions that can cause or are associated with chronic pelvic pain leads to conservative management proposals based on the available evidence. Finally, nonoperative interventional strategies are described, which target the pain system from a cognitive behavioral perspective, address movement dysfunctions, and address interventional pain technique possibilities.

Chronic Pelvic Pain: Is It Time for an Algorithmic Approach?

“…Thus, in common practice, patients receive treatments that vary by both geographic location as well as the specialty of origin of the treating physicians. Similar to the recommendations of Nelson et al., 3 we agree the treatment of pelvic pain should involve a multidisciplinary approach and should ideally involve evaluation and treatment only by physicians, physical therapists, and psychologists well‐versed in the complex biopsychosocial and pathophysiologic contributors to the development and maintenance of CPP.…”

Gynecologic and obstetric implications of the joint hypermobility syndrome (a.k.a. Ehlers–Danlos syndrome hypermobility type) in 82 Italian patients

“…Therefore, while at the moment there is no reason to contraindicate pregnancy in JHS/EDS-HT, the risk of intolerable symptom amplification should be considered and preventive strategies, hopefully within a multidisciplinary approach, are expected in every woman with JHS/EDS-HT planning motherhood. Such strategies may include gentle, experienced manual therapy, stress management, sleep hygiene, and relaxation techniques for preventing/early treating pelvic pain and gait abnormalities [Nelson et al, 2012], and application of nonpharmacological measures for contrasting dysautonomia [Mathias t al., 2011] among others.…”

Ehlers-Danlos Syndrome, Hypermobility Type: An Underdiagnosed Hereditary Connective Tissue Disorder with Mucocutaneous, Articular, and Systemic Manifestations

“…JHS/EDS-HT pelvic pain is best managed with a multispecialist approach but a specific schedule is lacking; general recommendations are well summarized in Nelson et al [156]. …”