Современный взгляд на хроническую тазовую боль в гинекологии

Abstract

Introduction. Chronic pelvic pain (CPP) is a long-term pain condition lasting at least 3–6 months, often accompanied by a significant reduction in quality of life. It can be either cyclic or constant and occurs in both sexes, but is particularly common among women. The etiological spectrum of CPP includes gynecological, urological, gastroenterological, psychoemotional, and neurological factors. Central pain mechanisms, such as central nervous system sensitization, play a key role in the pathogenesis, especially in the presence of comorbid conditions, including irritable bowel syndrome, endometriosis, and interstitial cystitis.

Materials and Methods. The analysis is based on current clinical guidelines, including the European Association of Urology (EAU) classification, systematization of clinical forms, and diagnostic approaches. A multidimensional axial assessment system is applied, including anatomical pain distribution, temporal characteristics, psychoemotional aspects, and comorbid conditions. Particular attention is paid to a multidisciplinary approach involving gynecological, urological, gastroenterological, and psychiatric evaluation, as well as instrumental methods (ultrasound, MRI, laparoscopy), clinical scales (PHQ-9, NIH-CPSI, IIEF), physical examination, and diagnostic nerve blocks.

Conclusion. Successful management of CPP requires a comprehensive strategy focused on addressing both somatic and psychoemotional components of pain. A multidisciplinary approach—including pharmacological therapy, pelvic floor physiotherapy, cognitive behavioral therapy, and, when necessary, surgical intervention or neuromodulation—ensures the best outcomes. Given the clinical heterogeneity and high prevalence of CPP, especially among women with comorbidities, early diagnosis, individualized treatment, and interdisciplinary collaboration are essential.