Chronic Pelvic Pain in Women

1 Introduction.- 1.1 Frequency of Chronic Pain.- 1.2 Frequent Incorrect Diagnoses.- 1.3 Two-Staged Clinical Investigation of Chronic Pain Syndromes.- 2 Anatomy and Physiology of Gynecologic Pain.- 2.1 Innervation.- 2.2 Central Pathways and Modulating Influences.- 2.3 Sensitivity of the Genital Organs.- 3 General Characteristics of Chronic Pain of Gynecologic Origin.- 3.1 Most Frequent Localizations.- 3.2 Radiation or Spread of Pain.- 3.3 Time-Intensity Relationship During the Menstrual Cycle.- 3.4 Hyperalgesia of the Abdominal Wall and of Back in Chronic Pain Syndromes.- 3.5 Other Useful Data.- 4 Examination of Patients with Chronic Pain Syndromes.- 4.1 The Patient and Her Complaints.- 4.2 Clinical Examination and Some Special Explorations.- 4.3 Gynecologic Laparoscopy.- 4.4 Interpretation of Data: Some Causes of Diagnostic Errors.- 5 Psychological Aspects of the Pain Experience.- 5.1 General Considerations.- 5.2 Behavioral Patterns of Patients with Acute and Chronic Pain.- 5.3 Presentation of the Pain Complaint.- 6 Genital Prolapse and Retroversion of the Uterus.- 6.1 Genital Prolapse.- 6.2 Retroversion and Retroflexion of the Uterus.- 7 Parietal Pain.- 7.1 Possible Causes of Pain Arising in the Abdominal Wall.- 7.2 Meaning of Parietal Tenderness in Chronic Abdominal Pain Syndromes.- 7.3 Characteristics of Parietal Pain Due to Irritation of Peripheral Nerves of the Abdominal Wall.- 7.4 Some Examples of Parietal Pain in Gynecologic Practice.- 7.5 Some Examples of Abdominal Parietal Pain in Obstetric Practice.- 8 Dysmenorrhea.- 8.1 Incidence.- 8.2 Classification.- 8.3 Primary Dysmenorrhea.- 8.4 Secondary Dysmenorrhea.- 9 Midcycle Pain.- 9.1 Severe Form.- 9.2 Less Severe Forms.- 9.3 Pathogenesis.- 9.4 Treatment.- 10 Premenstrual Tension.- 10.1 Symptoms.- 10.2 Pathogenesis.- 10.3 Treatment.- 11 Endometriosis.- 11.1 Incidence.- 11.2 Diagnosis.- Spontaneous Pain.- 11.3 Various Pain Localizations in Endometriosis.- 11.4 Mechanism of Pain Due to Endometriosis.- 11.5 Acute Pain Syndromes Due to Endometriosis.- 11.6 Management of Endometriosis.- 12 Chronic Pelvic Inflammatory Disease.- 12.1 Chronic Parametritis Due to a Chronic Cervical Infection.- 12.2 Chronic Salpingo-Oophoritis.- 13 Ovarian Pain.- 13.1 Ovarian Cysts.- 13.2 Ovarian Remnant Syndrome.- 13.3 Residual Ovary Syndrome.- 13.4 Chronic Oophoritis and Perioophoritis.- 13.5 Ovarian Dyspareunia.- 13.6 Ovarian Tumors.- 13.7 Some Rare Causes of Ovarian Pain.- 14 Dyspareunia.- 14.1 Varieties of Dyspareunia.- 14.2 Superficial Dyspareunia.- 14.3 Vaginal Dyspareunia.- Psychogenic Dyspareunia.- 14.4 Deep Dyspareunia.- 14.5 Psychological Factors.- 15 Acute and Chronic Lower Abdominal Pain of Enterocolic Origin.- 15.1 Innervation and Visceral Sensations.- 15.2 General Considerations of Enterocolic Pain.- 15.3 Abdominal Pain Patterns.- 15.4 Enterocolic Disorders Causing Lower Abdominal Pain.- 16 Low Back Pain in Women.- 16.1 Introduction.- 16.2 Definition of Low Back Pain.- 16.3 Medicosocial Importance of Low Back Pain.- 16.4 Origin of Low Back Pain.- 16.5 Investigation of Low Back Pain.- 16.6 Etiology of Low Back Pain.- 16.7 General Rules of Treatment and Conduct for Patients with Back Complaints.- 17 Chronic Pelvic Pain of Urologic Origin.- 17.1 Introduction.- 17.2 Recurrent Cystourethritis.- 17.3 Intractable Suprapubic Pain Due to Infiltrating Bladder Tumors.- 17.4 Pelvic Kidney Ectopia.- 17.5 Nephroptosis.- 17.6 Ureteral Causes of Pelvic Pain.- 18 Chronic Pelvic Pain Without Obvious Pathology.- 18.1 Introduction.- 18.2 Description of the Syndrome.- 18.3 Prevalence.- 18.4 Pathogenesis.- 18.5 Therapeutic Strategy.- 19 Treatment of Pain Due to Gynecologic Tumors Localized in the Pelvis.- 19.1 Introduction.- 19.2 Treatment of Cancer Pain with Analgesic Drugs.- 19.3 Treatment of Cancer Pain with Nerve Blocks.- 19.4 Neurosurgical Treatment of Cancer Pain of Gynecologic Origin.- 19.5 Conclusion.- 20 Subject Index.