How is the patient evaluated?

Since the pain is subjective, the collection of data related to the pain is the main form of evaluation. Exploration and additional testing allow a better understanding of the pain.

Natalia Gennaro, expert gynecologist, specialised in laparoscopic surgery and the pelvic floor.

To undergo an evaluation for chronic pelvic pain, the following is required:

· Basal and periodic evaluation of intensity.

· Detailed clinical history including: chronology of onset and progression, nature, focus of perceived pain and eradication, factors that worsen or alleviate pain and accompanying symptoms.

· Questions regarding thoughts, emotions and behaviour related to the pain.

· Meticulous examination, not only of the painful area, but of the entire body, particularly the musculoskeletal and nervous systems.

· Follow-up tests to identify well-defined syndromes.

· Periodic review of the process and response to treatment.

Within chronic pelvic pain, certain conditions have been “well-defined”, such as pudendal nerve neuralgia, interstitial cystitis and endometriosis, and it’s very important to identify and treat these with a strategy based on scientific testing. However, in many cases (30%), the injury is not located and the patient is diagnosed with neuraxial central sensitization.

At present, there is no doubt that these central changes can produce states of visceral or muscular hypersensitivity with long-term pain, and sensitive dysesthesia and functional abnormalities with cognitive, behavioural, emotional and sexual consequences with long-term pain.

Treatment is designed to treat the cause when found. Therefore, it could be medical treatment, which includes changing habits, physiotherapy, electrostimulation, medicine or surgery. In complex cases, a multidisciplinary treatment may be required from gynecologists, urologists, dermatologists, psychiatrists, psychologists, physiotherapists and anesthesiologists who specialize in pain management.

The prognosis is usually favorable, with improvement of pain and quality of life in up to 90% of cases. In 60% of all cases, patients with a greater resistance to treatment usually present a spontaneous improvement after 3 years.