Pelvic pain

Pelvic pain is a symptom that can affect both women and men. The pelvic pain that persists for a period of 3 months or more to be considered chronic while less than this duration is considered acute. The pain may indicate the existence of poorly-understood conditions that likely represent abnormal psychoneuromuscular function.

Female
Most women, at some time in their lives, experience pelvic pain. Many different etiologies have been proposed, including: Women with symptoms of pain may want to see a gynecologist if problems don't go away after a few days, and workup should begin with a careful history and examination, followed by a pregnancy test. Some women may also need bloodwork or additional imaging studies, and a handful may also benefit from having surgical evaluation using small telescopes (laparoscopy). Many women will also benefit from a consultation with a physical therapist, a trial of anti-inflammatory medications, hormonal therapy, or even neurological agents.
 * endometriosis
 * infection or post-infectious neurological hypersensitivity
 * exaggerated bladder, bowel, or uterine pain sensitivity (also known as visceral pain)
 * ovarian cysts, uterine leiomyoma - often found in asymptomatic patients as well, however
 * less common emergencies: ovarian torsion - sudden loss of circulation to the ovary, appendicitis - infection of one part of the intestine, with right lower abdominal pain
 * pelvic girdle pain (SPD or DSP)

This is a condition that although common, direly needs to be studied more closely.

As girls enter gynecologic maturity, pelvic or abdominal pain becomes a frequent complaint.

Chronic pelvic pain (CPP) accounts for 10% of all visits to gynecologists. In addition, CPP is the reason for 20 - 30% of all laparoscopies in adults.


 * Gynecologic Etiologies
 * Dysmenorrhea
 * Endometriosis
 * Müllerian abnormalities
 * Pelvic inflammatory disease
 * Ovarian abnormalities


 * Abdominal Etiologies
 * Loin pain hematuria syndrome
 * Proctitis
 * Colitis

Pelvic pain and sexual abuse
While there are physical causes of such pain psychologists care interested in possible psychological causes for the expression of such symptoms. One possible cause is sexual abuse. This is perhaps an unresearched area.

Male
Men also experience chronic pelvic pain. In men it is called Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) and is also known as chronic nonbacterial prostatitis. Men in this category have no known infection, but do have extensive pelvic pain lasting more than 3 months. There are no standard diagnostic tests; diagnosis is by exclusion of other disease entities. Multimodal therapy is the most successful treatment option, and includes α-blockers, phytotherapy, and protocols aimed at quieting the pelvic nerves through myofascial trigger point release with psychological re-training for anxiety control. Antibiotics are not recommended.

Differential diagnosis
In men, chronic pelvic pain (category IIIB) is often misdiagnosed as chronic bacterial prostatitis and needlessly treated with antibiotics exposing the patient to inappropriate antibiotic use and unnecessarily to adverse effects with little if any benefit in most cases. Within a Bulgarian study, where by definition all patients had negative microbiological results, a 65% adverse drug reaction rate was found for patients treated with ciprofloxacin in comparison to a 9% rate for the placebo patients. This was combined with a higher cure rate (69% v 53%) found within the placebo group.