Chronic pelvic pain in women: etiology, pathogenesis and diagnostic approach

Vercellini, Paolo; Somigliana, Edgardo; Viganò, Paola; Abbiati, Annalisa; Barbara, Giussy; Fedele, Luigi

doi:10.1080/09513590802549858

Cited by 138Endometriosis Research and TreatmentGynecological conditions and treatmentsMenstrual Health and Disorders

Chronic pelvic pain in women: etiology, pathogenesis and diagnostic approach

Vercellini, Paolo, Somigliana, Edgardo, Viganò, Paola, Abbiati, Annalisa, Barbara, Giussy, Fedele, Luigi·2009·Gynecological Endocrinology

DOI 10.1080/09513590802549858

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Abstract

Chronic pelvic pain (CPP), defined as non-cyclic pain of 6 or more months, is a frequent disorder that may negatively affect health-related quality of life. In women several causes are recognised, although in a not negligible proportion of patients a definite diagnosis cannot be made. Different neurophysiological mechanisms are involved in the pathophysiology of CPP. Pain may be classified as nociceptive or non-nociceptive. In the first case the symptom originates from stimulation of a pain-sensitive structure, whereas in the second pain is considered neuropatic or psychogenic. Patients history is crucial and is generally of utmost importance for a correct diagnosis, being sometimes more indicative than several diagnostic investigations. The main contributing factors in women with CPP can still be identified by history and physical examination in most cases. Many disorders of the reproductive tract, urological organs, gastrointestinal, musculoskeletal and psycho-neurological systems may be associated with CPP. Excluding endometriosis, the most frequent causes of CPP are: post-operative adhesions, pelvic varices, interstitial cystitis and irritable bowel syndrome. CPP is a symptom, not a disease, and rarely reflects a single pathologic process. Gaining women's trust and developing a strong patient-physician relationship is of utmost importance for the long-term outcome of care.

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Destroying or removing lesions reduces pain in some endometriosis patients.
“The fact that surgical removal or destruction of lesions alleviates pain in some patients indicates that lesions contribute to pain (Vercellini et al., 2009b)”
From Chronic pelvic pain and endometriosis: translational evidence of the relationship and implications (2011) · cites this paper as Vercellini et al., 2009b
Endometrioma management is difficult because their link to pain is uncertain.
“Treating endometriomas is not straightforward as their association with pain is unclear (Chapron et al., 2002;Vercellini et al., 2009b).”
From Chronic pelvic pain and endometriosis: translational evidence of the relationship and implications (2011) · cites this paper as Vercellini et al., 2009b
At a second operation, some women no longer have endometriosis.
“Furthermore, not all women undergoing re-operation have endometriosis at second surgery (Vercellini et al., 2009b)”
From Chronic pelvic pain and endometriosis: translational evidence of the relationship and implications (2011) · cites this paper as Vercellini et al., 2009b
How severe pain is does not track with how extensive the disease is.
“Third, severity of pain symptoms does not correlate with extent of disease (Kennedy et al., 2005;Vercellini et al., 2009b).”
From Chronic pelvic pain and endometriosis: translational evidence of the relationship and implications (2011) · cites this paper as Vercellini et al., 2009b
Treating deeply infiltrating endometriosis lesions offers greater potential benefit than treating other lesion types.
“Treating DIE lesions has a greater potential for benefit than treating other lesion types (Fauconnier and Chapron, 2005;Vercellini et al., 2009b).”
From Chronic pelvic pain and endometriosis: translational evidence of the relationship and implications (2011) · cites this paper as Vercellini et al., 2009b

In up to half of carefully chosen patients, apparently complete surgery does not relieve pain for a year or more.
“First, seemingly complete surgical removal fails to alleviate pain for at least a year in up to 50% of carefully selected patients (Vercellini et al., 2009b).”
From Chronic pelvic pain and endometriosis: translational evidence of the relationship and implications (2011) · cites this paper as Vercellini et al., 2009b
Surgery for endometriosis in women with chronic pelvic pain follows a cancer-surgery principle of removing every lesion.
“The approach to surgical treatment of endometriosis in women with CPP is based on the oncologic principle of removing all lesions (Howard, 2003;Vercellini et al., 2009b).”
From Chronic pelvic pain and endometriosis: translational evidence of the relationship and implications (2011) · cites this paper as Vercellini et al., 2009b
Pain frequently recurs after lesion surgery has relieved it, at times with no new lesions visible.
“Second, even in patients whose pain was alleviated by surgically treating lesions, pain often returns, sometimes without evidence of new lesions (Abbott et al., 2003;Vercellini et al., 2009b).”
From Chronic pelvic pain and endometriosis: translational evidence of the relationship and implications (2011) · cites this paper as Vercellini et al., 2009b
Removing the pseudocapsule lowers the chance of recurrence.
“Although excision of the pseudocapsule helps to prevent recurrence”
From Chronic pelvic pain and endometriosis: translational evidence of the relationship and implications (2011) · cites this paper as Vercellini et al., 2009b
Such excision can reduce ovarian reserve and lead to infertility or early ovarian failure.
“excision may lead to diminished ovarian reserve, subsequent infertility and premature ovarian insufficiency (Vercellini et al., 2006b(Vercellini et al., , 2009b)).”
From Chronic pelvic pain and endometriosis: translational evidence of the relationship and implications (2011) · cites this paper as Vercellini et al., 2009b
Surgical visual inspection, though standard, may fail to accurately record the location, depth, and extent of endometriosis lesions.
“Visual survey at surgery is the accepted standard, but may not accurately catalogue the location, depth and extent of lesions.”
From Chronic pelvic pain and endometriosis: translational evidence of the relationship and implications (2011) · cites this paper as Vercellini et al., 2009b
The contribution of adhesions to pain in endometriosis remains poorly understood.
“The role of adhesions in pain and endometriosis is poorly understood”
From Chronic pelvic pain and endometriosis: translational evidence of the relationship and implications (2011) · cites this paper as Vercellini et al., 2009b
Minimal and mild endometriosis are not always confirmed by histology, so cases may be misclassified.
“Furthermore, minimal and mild disease are not necessarily histologically confirmed, which may result in misclassifying cases”
From Chronic pelvic pain and endometriosis: translational evidence of the relationship and implications (2011) · cites this paper as Vercellini et al., 2009b
Women with endometriosis have a higher rate of other pain syndromes associated with peripheral and central sensitization, including irritable bowel syndrome, painful bladder syndrome, fibromyalgia, and migraine headache.
“women with endometriosis have a higher rate of other pain syndromes associated with peripheral and central sensitization such as irritable bowel syndrome, painful bladder syndrome, fibromyalgia and migraine headache”
From Chronic pelvic pain and endometriosis: translational evidence of the relationship and implications (2011) · cites this paper as Vercellini et al., 2009c
Change in endometriosis score has been used to assess treatment effect under the assumption, unsupported by evidence, that lesion score correlates with pain score.
“Third, change in endometriosis score has been used to assess treatment effect with the assumption, but no evidence, that lesion score correlates with pain score”
From Chronic pelvic pain and endometriosis: translational evidence of the relationship and implications (2011) · cites this paper as Vercellini et al., 2009b

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Chronic pelvic pain and endometriosis: translational evidence of the relationship and implications
Stratton, P., & Berkley, K. J. (2011) · Human Reproduction Update · doi:10.1093/humupd/dmq050 · Cited by 442 · see citing works
The role of the Hoxa10/HOXA10 gene in the etiology of endometriosis and its related infertility: a review
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Stress-Induced Visceral Pain: Toward Animal Models of Irritable-Bowel Syndrome and Associated Comorbidities
Moloney, R. D., O’Mahony, S. M., Dinan, T. G., & Cryan, J. F. (2015) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2015.00015 · Cited by 167 · see citing works
Ovarian hormones and chronic pain: A comprehensive review
Hassan, S. I., Muere, A., & Einstein, G. (2014) · Pain · doi:10.1016/j.pain.2014.08.027 · Cited by 115 · see citing works
Chronic Pelvic Pain in Endometriosis: An Overview
Triolo (2013) · Journal of Clinical Medicine Research · doi:10.4021/jocmr1288w · Cited by 110 · see citing works
Physical examination techniques for the assessment of pelvic floor myofascial pain: a systematic review
Meister, M., Shivakumar, N., Sutcliffe, S. S., Spitznagle, T. M., & Lowder, J. L. (2018) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2018.06.014 · Cited by 85 · see citing works
Assessing burden, risk factors, and perceived impact of uterine fibroids on women’s lives in rural Haiti: implications for advancing a health equity agenda, a mixed methods study
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Priorities for Endometriosis Research: A Proposed Focus on Deep Dyspareunia
Vercellini, P., Meana, M., Hummelshøj, L., Somigliana, E., Viganò, P., & Fedele, L. (2010) · Reproductive Sciences · doi:10.1177/1933719110382921 · Cited by 76 · see citing works
Self-citation
Social isolation in women with endometriosis and chronic pelvic pain
Mellado, B. H., Falcone, A. C. M., Poli‐Neto, O. B., Rosa e Silva, J. C., Nogueira, A. A., & Candido‐dos‐Reis, F. J. (2016) · International Journal of Gynecology & Obstetrics · doi:10.1016/j.ijgo.2015.08.024 · Cited by 74 · see citing works
A review of the problematic adhesion prophylaxis in gynaecological surgery
Hirschelmann, A., Tchartchian, G., Wallwiener, M., Hackethal, A., & Wilde, R. L. D. (2011) · Archives of Gynecology and Obstetrics · doi:10.1007/s00404-011-2097-1 · Cited by 72 · see citing works
Gynecologic pain related to occupational stress among female factory workers in Tianjin, China
Sznajder, K. K., Harlow, S. D., Burgard, S. A., Wang, Y., Han, C., & Liu, J. (2014) · International Journal of Occupational and Environmental Health · doi:10.1179/2049396713y.0000000053 · Cited by 70 · see citing works
Maintenance therapy with dienogest following gonadotropin-releasing hormone agonist treatment for endometriosis-associated pelvic pain
Kitawaki, J., Kusuki, I., Yamanaka, K., & Suganuma, I. (2011) · European Journal of Obstetrics & Gynecology and Reproductive Biology · doi:10.1016/j.ejogrb.2011.03.012 · Cited by 65 · see citing works
Pelvic Pain in Transgender People Using Testosterone Therapy
Zwickl, S., Burchill, L., Wong, A. F. Q., Leemaqz, S., Cook, T., Angus, L. M., Eshin, K., Elder, C. V., Grover, S. R., Zajac, J. D., et al. (2023) · LGBT Health · doi:10.1089/lgbt.2022.0187 · Cited by 64 · see citing works
Neurobiological Mechanisms of Pelvic Pain
Origoni, M., Maggiore, U. L. R., Salvatore, S., & Candiani, M. (2014) · BioMed Research International · doi:10.1155/2014/903848 · Cited by 60 · see citing works
Adhesions after laparoscopic myomectomy: Incidence, risk factors, complications, and prevention
de Wilde, R.-L., Herrmann, A., la Roche, L. A. T.-D., Krentel, H., Cezar, C., de Wilde, M. S., & Devassy, R. (2020) · Gynecology and Minimally Invasive Therapy · doi:10.4103/gmit.gmit_87_20 · Cited by 57 · see citing works
Chronic Pelvic Pain: Assessment, Evaluation, and Objectivation
Passavanti, M. B., Pota, V., Sansone, P., Aurilio, C., Nardis, L. D., & Pace, M. C. (2017) · Pain Research and Treatment · doi:10.1155/2017/9472925 · Cited by 57 · see citing works
Deep Dyspareunia: Review of Pathophysiology and Proposed Future Research Priorities
Orr, N. L., Wahl, K., Joannou, A., Hartmann, D., Valle, L., Yong, P. J., International Society for the Study of Women’s Sexual Health’s (ISSWSH) Special Interest Group on Sexual Pain, Babb, C. R., Kramer, C. W., Kellogg‐Spadt, S., et al. (2019) · Sexual Medicine Reviews · doi:10.1016/j.sxmr.2018.12.007 · Cited by 57 · see citing works
Review: Pelvic nerves – from anatomy and physiology to clinical applications
Alkatout, İ., Wedel, T., Pape, J., Possover, M., & Dhanawat, J. (2021) · Translational Neuroscience · doi:10.1515/tnsci-2020-0184 · Cited by 56 · see citing works
Influence of Nerve Growth Factor in Endometriosis-Associated Symptoms
Barcena, M. L., Arnold, J., Vercellino, G. F., Chiàntera, V., Ebert, A. D., Schneider, A., & Mechsner, S. (2011) · Reproductive Sciences · doi:10.1177/1933719111410711 · Cited by 53 · see citing works
Gut Microbiota and Endometriosis: Exploring the Relationship and Therapeutic Implications
Xholli, A., Cremonini, F., Perugi, I., Londero, A. P., & Cagnacci, A. (2023) · Pharmaceuticals · doi:10.3390/ph16121696 · Cited by 49 · see citing works
How to Understand the Complexity of Endometriosis-Related Pain
Chiàntera, V., Abesadze, E., & Mechsner, S. (2017) · Journal of Endometriosis and Pelvic Pain Disorders · doi:10.5301/je.5000271 · Cited by 49 · see citing works
Chronic pelvic pain improvement: impact on quality of life and mood
Cagnacci, A., Vecchia, E. D., & Xholli, A. (2019) · Gynecological Endocrinology · doi:10.1080/09513590.2018.1540571 · Cited by 44 · see citing works
Ultramicronized palmitoylethanolamide reduces viscerovisceral hyperalgesia in a rat model of endometriosis plus ureteral calculosis
Iuvone, T., Affaitati, G., Filippis, D. D., Lopopolo, M., Grassia, G., Lapenna, D., Negro, L., Costantini, R., Vaia, M., Cipollone, F., et al. (2015) · Pain · doi:10.1097/j.pain.0000000000000220 · Cited by 42 · see citing works
Endometriose: Eine oft verkannte Schmerzerkrankung
Mechsner, S. (2016) · Der Schmerz · doi:10.1007/s00482-016-0154-1 · Cited by 41 · see citing works
Dietary therapy: a new strategy for management of chronic pelvic pain
Sesti, F., Capozzolo, T., Pietropolli, A., Collalti, M., Bollea, M. R., & Piccione, E. (2010) · Nutrition Research Reviews · doi:10.1017/s0954422410000272 · Cited by 41 · see citing works
When and how should peritoneal endometriosis be operated on in order to improve fertility rates and symptoms? The experience and outcomes of nearly 100 cases
Dückelmann, A. M., TAUBE, E. T., Abesadze, E., Chiàntera, V., Sehouli, J., & Mechsner, S. (2021) · Archives of Gynecology and Obstetrics · doi:10.1007/s00404-021-05971-6 · Cited by 38 · see citing works
Laparoscopic myomectomy—The gold standard
Herrmann, A., & Wilde, R. L. D. (2014) · Gynecology and Minimally Invasive Therapy · doi:10.1016/j.gmit.2014.02.001 · Cited by 37 · see citing works
Ureteral Endometriosis: A Rare and Underdiagnosed Cause of Kidney Dysfunction
Ponticelli, C. E., Graziani, G., & Montanari, E. (2009) · Nephron Clinical Practice · doi:10.1159/000254380 · Cited by 37 · see citing works
Understanding and managing pelvic girdle pain from a person-centred biopsychosocial perspective
Beales, D., Slater, H., Palsson, T., & O'Sullivan, P. (2020) · Musculoskeletal Science and Practice · doi:10.1016/j.msksp.2020.102152 · Cited by 36 · see citing works
The peritoneum—an important factor for pathogenesis and pain generation in endometriosis
Barcena, M. L., & Mechsner, S. (2014) · Journal of Molecular Medicine · doi:10.1007/s00109-014-1135-4 · Cited by 33 · see citing works
The use of home remedies and complementary health approaches in endometriosis
Schwartz, A. S. K., Gross, E., Geraedts, K., Rauchfuss, M., Wölfler, M. M., Häberlin, F., von Orelli, S., Eberhard, M., Imesch, P., Imthurn, B., et al. (2019) · Reproductive BioMedicine Online · doi:10.1016/j.rbmo.2018.10.009 · Cited by 32 · see citing works
Intermenstrual Pelvic Pain, Quality of Life and Mood
Grandi, G., Xholli, A., Ferrari, S., Cannoletta, M., Volpe, A., & Cagnacci, A. (2012) · Gynecologic and Obstetric Investigation · doi:10.1159/000343997 · Cited by 31 · see citing works
Female pelvic congestion syndrome: how can CT and MRI help in the management decision?
Osman, A., Mordi, A., & Khattab, R. T. (2020) · British Journal of Radiology · doi:10.1259/bjr.20200881 · Cited by 30 · see citing works
Surgical interventions for the management of chronic pelvic pain in women
Leonardi, M., Armour, M., Gibbons, T., Cave, A. E., As‐Sanie, S., Condous, G., & Cheong, Y. C. (2021) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd008212.pub2 · Cited by 30 · see citing works
Evaluation of the sacral nerve plexus in pelvic endometriosis by three‐dimensional MR neurography
Zhang, X., Li, M., Guan, J., Wang, H. J., Li, S., Guo, Y., & Liu, M. (2016) · Journal of Magnetic Resonance Imaging · doi:10.1002/jmri.25435 · Cited by 30 · see citing works
The prevalence and potential determinants of dysmenorrhoea and other pelvic pain in women: a prospective study
Righarts, A., Osborne, L., CONNOR, J. L., & Gillett, W. R. (2018) · BJOG An International Journal of Obstetrics & Gynaecology · doi:10.1111/1471-0528.15247 · Cited by 29 · see citing works
Dynamic weight bearing as a non‐reflexive method for the measurement of abdominal pain in mice
Laux‐Biehlmann, A., Boyken, J., Dahllöf, H., Schmidt, N., Zollner, T. M., & Nagel, J. (2015) · European Journal of Pain · doi:10.1002/ejp.800 · Cited by 28 · see citing works
International Journal of Current Research in Medical Sciences
Journal, I. (2015) · doi:10.6084/m9.figshare.1597643.v1 · Cited by 28 · see citing works
Brain-Derived Neurotrophic Factor in Plasma of Women with Endometriosis
Giannini, A., Bucci, F., Luisi, S., Cela, V., Pluchino, N., Merlini, S., Casarosa, E., Russo, M., Cubeddu, A., Daino, D., et al. (2010) · Journal of Endometriosis · doi:10.1177/228402651000200305 · Cited by 27 · see citing works
Attributes and Barriers to Care of Pelvic Pain in University Women
Mann, J., Shuster, J. J., & Moawad, N. S. (2013) · Journal of Minimally Invasive Gynecology · doi:10.1016/j.jmig.2013.05.003 · Cited by 27 · see citing works
Antiproliferative and apoptotic effects of norethisterone on endometriotic stromal cells in vitro
Minami, T., Kosugi, K., Suganuma, I., Yamanaka, K., Kusuki, I., Oyama, T., & Kitawaki, J. (2012) · European Journal of Obstetrics & Gynecology and Reproductive Biology · doi:10.1016/j.ejogrb.2012.08.023 · Cited by 26 · see citing works
Before the onset of interstitial cystitis/bladder pain syndrome, the presence of multiple non-bladder syndromes is strongly associated with a history of multiple surgeries
Warren, J. W., Morozov, V., Howard, F. M., Wesselmann, U., Gallicchio, L. M., LANGENBERG, P. W., & Clauw, D. J. (2013) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2013.10.013 · Cited by 26 · see citing works
Chronic pelvic pain: An imaging approach
Juhan, V. (2015) · Diagnostic and Interventional Imaging · doi:10.1016/j.diii.2015.07.010 · Cited by 25 · see citing works
Visceral Pain and Psychiatric Disorders
Felice, V. D., Moloney, R. D., Cryan, J. F., Dinan, T. G., & O’Mahony, S. M. (2015) · Modern trends in psychiatry · doi:10.1159/000435936 · Cited by 25 · see citing works
Chinese expert consensus on the prevention of abdominal pelvic adhesions after gynecological tumor surgeries
Lang, J., Ma, D., Xiang, Y., Hua, K., Liu, K., Pan, L., Wang, P., Yao, S., Zhao, F., Cheng, W., et al. (2020) · Annals of Translational Medicine · doi:10.21037/atm.2020.02.53 · Cited by 21 · see citing works
Prevalence of Endometriosis and Its Symptoms among Young Jordanian Women with Chronic Pelvic Pain Refractory to Conventional Therapy
Al‐Jefout, M., Alnawaiseh, N. A., Yaghi, S., & Alqaisi, A. (2017) · Journal of Obstetrics and Gynaecology Canada · doi:10.1016/j.jogc.2017.06.042 · Cited by 20 · see citing works
Clinical Management of Chronic Pelvic Pain in Endometriosis Unresponsive to Conventional Therapy
Pereira, A., Trujillano, M. H., Argüello, G. V., Fuentes, L., González, S., Mendiola, A., & Pérez‐Medina, T. (2022) · Journal of Personalized Medicine · doi:10.3390/jpm12010101 · Cited by 17 · see citing works
The role of catastrophizing in chronic cyclical pelvic pain: A systematic review and meta-analysis
Rabinowitz, E. P., Sayer, M. A., & Delahanty, D. L. (2023) · Women s Health · doi:10.1177/17455057231199949 · Cited by 15 · see citing works
Long term follow-up concerning safety and efficacy of novel adhesion prophylactic agent for laparoscopic myomectomy in the prospective randomized ADBEE study
Cezar, C., Tchartchian, G., Korell, M., Ziegler, N., Senshu, K., de Wilde, M. S., Herrmann, A., Larbig, A., & Wilde, R. L. D. (2016) · Best Practice & Research Clinical Obstetrics & Gynaecology · doi:10.1016/j.bpobgyn.2016.06.003 · Cited by 15 · see citing works
Effects of an Individualized Comprehensive Rehabilitation Program on Impaired Postural Control in Women With Chronic Pelvic Pain: A Randomized Controlled Trial
Rodríguez‐Torres, J., López‐López, L., Martos, I. C., Román, E. P., Santiago, M. G., & Valenza, M. C. (2020) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2020.02.019 · Cited by 15 · see citing works
Effects of low‐dose combined drospirenone–ethinylestradiol on perimenstrual symptoms experienced by women with endometriosis
Tanaka, Y., Mori, T., Ito, F., Koshiba, A., Kusuki, I., & Kitawaki, J. (2016) · International Journal of Gynecology & Obstetrics · doi:10.1016/j.ijgo.2016.05.004 · Cited by 14 · see citing works
Impact of Pelvic Pain and Endometriosis on Patient-Reported Outcomes and Experiences of Benign Hysterectomy: A Study from the Swedish National Register for Gynecological Surgery
Grundström, H., Alehagen, S., Berterö, C., & Kjølhede, P. (2017) · Journal of Women s Health · doi:10.1089/jwh.2017.6546 · Cited by 14 · see citing works
The steroidogenic factor-1 protein is not expressed in various forms of endometriosis but is strongly present in ovarian cortical or medullary mesenchymatous cells adjacent to endometriotic foci
Noël, J., Anaf, V., Borghese, B., Vaiman, D., Fayt, I., & Chapron, C. (2011) · Fertility and Sterility · doi:10.1016/j.fertnstert.2011.01.131 · Cited by 14 · see citing works
Foam Sclerotherapy in Pelvic Congestion Syndrome
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Characterization of Common Genetic Variants in P2RX7 and Their Contribution to Chronic Pain Conditions
Zorina-Lichtenwalter, K., Ase, A. R., Verma, V., Machuca‐Parra, A. I., Komarova, S. V., Khadra, A., Séguéla, P., & Diatchenko, L. B. (2023) · Journal of Pain · doi:10.1016/j.jpain.2023.09.011 · Cited by 12 · see citing works
Balance ability and posture in postmenopausal women with chronic pelvic pain
Fuentes-Márquez, P., Rodríguez‐Torres, J., Valenza, M. C., Ortíz‐Rubio, A., Ariza-Mateos, M. J., & Martos, I. C. (2018) · Menopause The Journal of The North American Menopause Society · doi:10.1097/gme.0000000000001086 · Cited by 12 · see citing works
Chronic pelvic pain and the role of exploratory laparoscopy as diagnostic and therapeutic tool: a retrospective observational study
Brichant, G., Denef, M., Tebache, L., Poismans, G., Pinzauti, S., Dechenne, V., & Nisolle, M. (2018) · Gynecological Surgery · doi:10.1186/s10397-018-1045-5 · Cited by 11 · see citing works
Pelvic floor dysfunctions in women with systemic lupus erythematosus: A cross-sectional study
Bifani, B. E., Sato, T. D. O., dos Santos, G. B., Serrão, P. R. M. D. S., Rocha, A. P. R., & Carvalho, C. (2022) · International Urogynecology Journal · doi:10.1007/s00192-022-05310-6 · Cited by 10 · see citing works
The Peripheral Neuroanatomy of the Pelvic Floor
Gorniak, G. C., & King, P. M. (2016) · Journal of Womenʼs Health Physical Therapy · doi:10.1097/jwh.0000000000000044 · Cited by 10 · see citing works
Trigger Point Injections for Pelvic Floor Myofascial Spasm Refractive to Primary Therapy
Fouad, L., Pettit, P. D., Threadcraft, M. A., Wells, A., Micallef, A., & Chen, A. H. (2017) · Journal of Endometriosis and Pelvic Pain Disorders · doi:10.5301/jeppd.5000283 · Cited by 10 · see citing works
Examen pelvien en gynécologie et obstétrique : recommandations pour la pratique clinique
Deffieux, X., Rousset‐Jablonski, C., Gantois, A., Brillac, T., Maruani, J., Maitrot‐Mantelet, L., Mignot, S., Gaucher, L., Athiel, Y., Baffet, H., et al. (2023) · Gynécologie Obstétrique Fertilité & Sénologie · doi:10.1016/j.gofs.2023.04.001 · Cited by 9 · see citing works
Chronic pelvic pain: comorbidity between chronic musculoskeletal pain and vulvodynia
Biasi, G., Sabatino, V. D., Ghizzani, A., & Galeazzi, M. (2014) · Reumatismo · doi:10.4081/reumatismo.2014.768 · Cited by 8 · see citing works
Do women with suspected endometriosis benefit from pelvic examination to improve diagnostic and management strategy?
Dabi, Y., Fauconnier, A., Rousset‐Jablonski, C., Tavenet, A., Pizzoferrato, A., & Deffieux, X. (2024) · Journal of Gynecology Obstetrics and Human Reproduction · doi:10.1016/j.jogoh.2024.102724 · Cited by 7 · see citing works
Do MicroRNAs Modulate Visceral Pain?
Tao, Z.-Y., Yang, X. W., Li, J., Traub, R. J., & Cao, D. (2018) · BioMed Research International · doi:10.1155/2018/5406973 · Cited by 6 · see citing works
The structure, nature and intensity of painin various forms of external genital endometriosis
Олеговна, Е. Т. (2016) · Journal of obstetrics and women s diseases · doi:10.17816/jowd65224-30 · Cited by 6 · see citing works
Evaluating the Effectiveness of Radiofrequency in Multimodal Physiotherapy for Postpartum Pelvic Pain: The RASDOP Protocol—A Mixed-Methods Study
Navarro-Brazález, B., Lorenzo-Gallego, L., la Mata, P. R.-D., Torres-Lacomba, M., Vergara-Pérez, F., Sánchez-Sánchez, B., & Méndez, N. I. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14051489 · Cited by 5 · see citing works
Evaluation of the content and the pathogenetic role of cytokines in the peritoneal fluid in patients with deep infiltrative endometriosis
Tsitskarava, D. Z., Yarmolinskaya, M. I., Selutin, A. V., & Selkov, S. А. (2017) · Journal of obstetrics and women s diseases · doi:10.17816/jowd66138-45 · Cited by 5 · see citing works
Negative laparoscopy unveiled
Jarrell, J. F., & Arendt‐Nielsen, L. (2018) · Journal of Endometriosis and Pelvic Pain Disorders · doi:10.1177/2284026517749478 · Cited by 5 · see citing works
Incidence of Chronic Pelvic Pain in Females Attending a Gynaecology Outpatient Department
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Reliability and agreement of three-dimensional/four-dimensional transperineal ultrasound in women with chronic pelvic pain
Aparecida, M., Herren, H., DOS-REIS, F. J. C., Costa, F. D. S., Silva, J. C. R. E., Nogueira, A. A., & Poli‐Neto, O. B. (2021) · Clinical and Experimental Obstetrics & Gynecology · doi:10.31083/j.ceog.2021.03.2298 · Cited by 4 · see citing works
Pain after laparoscopic endometriosis-specific vs. hysterectomy surgeries: A retrospective cohort analysis
Yagur, Y., Engel, O., Burstein, R., Bsharat, J., Weitzner, O., Daykan, Y., Klein, Z., & Schonman, R. (2024) · PLoS ONE · doi:10.1371/journal.pone.0301074 · Cited by 3 · see citing works
Douleurs pelviennes chroniques
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Cervical Tenderness (Parametropathy) is a Diagnostic Tool for the Chronic Pelvic Pain Syndrome
Weinschenk, S. W., Strowitzki, T., Selçuki, N. F. T., Zivanovic, O., Gerhardt, A., & Feißt, M. (2025) · Pain and Therapy · doi:10.1007/s40122-025-00760-4 · Cited by 3 · see citing works
Plastic and reconstructive uterus operations by minimally invasive surgery? A review on myomectomy
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Abdominal wall endometriosis occurring after cesarean section: an underestimated complication
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The Tpl2‐MEK pathway plays a critical role in spheroid‐cultured endometriotic stromal cells
Minami, T., Tsuzuki, Y., Tanaka, Y., Kitawaki, J., & Mori, T. (2023) · American Journal of Reproductive Immunology · doi:10.1111/aji.13689 · Cited by 3 · see citing works
Endometriose: Pathogenese, Symptome und Diagnostik
Mechsner, S. (2015) · Springer eBooks · doi:10.1007/978-3-662-43669-1_5 · Cited by 3 · see citing works
Proposed mechanisms of the development of endometriosis-associated chronic pelvic pain among adolescents
Belova, I. S., Khaschenko, E. P., & Uvarova, E. V. (2022) · Pediatric and Adolescent Reproductive Health · doi:10.33029/1816-2134-2022-18-1-34-40 · Cited by 3 · see citing works
Risk of endometriosis, adenomyosis, and related symptoms among female offspring according to conception by assisted reproductive technologies
Magnus, M. C., Alavi, D. H., Nydal, S., Fraser, A., Lawlor, D. A., Danielsson, K. C., Håberg, S. E., & Hanevik, H. I. (2025) · Fertility and Sterility · doi:10.1016/j.fertnstert.2025.10.002 · Cited by 2 · see citing works
Abuse history as a modifier of symptom phenotype in endometriosis: Insights from a multidimensional retrospective cohort
Freger, S. M., Cavalier, S., Cornea, M., Aharoni, S., Shetty, R. R., & Leonardi, M. (2026) · Acta Obstetricia Et Gynecologica Scandinavica · doi:10.1111/aogs.70167 · Cited by 2 · see citing works
Pain and Adverse Childhood Experiences
Katzman, W. G., & Fabbro, A. D. (2024) · Oxford University Press eBooks · doi:10.1093/med/9780197649176.003.0013 · Cited by 2 · see citing works
Dolor pélvico crónico: Más allá de la endometriosis
Villegas‐Echeverri, J. D., Jaramillo, J. D. L., Betancourt, A. L. H., & Isanoa, J. D. L. (2016) · Revista Peruana de Ginecología y Obstetricia · doi:10.31403/rpgo.v62i1886 · Cited by 2 · see citing works
The Effect of Affective Temperament, Pain Catastrophizing, and Anxiety Sensitivity on Pain Severity in Patients With Chronic Pelvic Pain: A Pilot Study
Günday, Ö. K., HARMANCI, H., & Şenol, Y. (2023) · Journal of Psychiatric Practice · doi:10.1097/pra.0000000000000742 · Cited by 2 · see citing works
Menstrual Problems for the MRCOG and Beyond
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Authors: Vercellini, P., Somigliana, E., Viganò, P., Abbiati, A., Barbara, G., & Fedele, L.
Affiliations: University of Milan (IT)
Corresponding author: Vercellini, Paolo
ORCID: Vercellini, Paolo
Somigliana, Edgardo
Viganò, Paola
Fedele, Luigi
Venue: Gynecological Endocrinology
Publisher: Informa UK Limited
Published: 2009-01
Volume: 25
Issue: 3
Pages: 149-158
ISSN: 0951-3590 (ISSN-L)
1473-0766
DOI: 10.1080/09513590802549858
OpenAlex: W2117120599
Cited by: 138
References: 79
Citations by year: 2026: 3 · 2025: 8 · 2024: 5 · 2023: 10 · 2022: 9 · 2021: 6 · 2020: 7 · 2019: 3 · 2018: 11 · 2017: 8 · 2016: 13 · 2015: 11 · 2014: 13 · 2013: 8 · 2012: 5
FWCI: 9.03
Type: journal article
Language: en
Open access: closed
Locations: Gynecological Endocrinology (publishedVersion)
PubMed (publishedVersion)
Funders: Università degli Studi di Milano
Topics: Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
Health Sciences › Medicine › Obstetrics and Gynecology › Gynecological conditions and treatments
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Menstrual Health and Disorders
Keywords: chronic pelvic pain, women, etiology, pathogenesis, neurophysiological mechanisms, nociceptive pain, neuropathic pain, psychogenic pain, diagnostic approach, medical history, endometriosis, postoperative adhesions, pelvic varices, interstitial cystitis, irritable bowel syndrome, reproductive tract disorders, urological diseases, musculoskeletal disorders, health-related quality of life, physician-patient relationship
MeSH terms: Chronic Disease, Family Health, Female, Gynecology, Humans, Reproductive History, Pelvic Pain

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Chronic pelvic pain in women: etiology, pathogenesis and diagnostic approach

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