Urogenital and pelvic pain

Abstract

Urogenital and pelvic pains are common and may have urologic, gynecologic, gastrointestinal, vascular, musculoskeletal, or neurologic origins. In the evaluation and treatment of these pains, it must be kept in mind that these sites of pain generation are private places associated with bodily functions that are associated with strong emotions: sexual function, defecation, and urination. After infection, ischemia, inflammation, obstruction, or neoplasm has been ruled out as likely etiologies, one is often left with simply a descriptive diagnosis coupled to an empiric treatment. Common diagnoses of chronic urogenital painful disorders include interstitial cystitis, prostatitis, endometriosis, and chronic pelvic pain without obvious pathology. The cost of these disorders to the US health system rivals that of chronic low back pain or asthma. These disorders are three to four times more prevalent in women than in men and difficult to diagnose due to the complex innervation of the pelvis: primary neural afferents travel by sympathetic, pelvic, and pudendal nerve pathways. Pain types may be generally categorized as neuropathic or as somatic or visceral nociceptive pains. Treatments are similar to those for other parts of the body but due to psychosocial modifiers are often more difficult to assess. Pain management is generally multimodal and commonly includes pharmacotherapy (antidepressants, muscle relaxants, anticonvulsants, opiates), surgery (laparoscopic versus open), and interventional procedures (spinal cord stimulations, sympathetic blocks). Other options include yoga, biofeedback, and physical therapy.