Chronic Pelvic Pain (CPP) in Women and Men

Chronic pelvic pain (CPP) occurs in women and men. The American College of Obstetricians and Gynecologists’ (ACOG) definition applies to women. The European Association of Urologists (EAU) revised their guidelines beginning in 2009 to include women and men in their definition of chronic pelvic pain. Chronic pelvic pain is a bladder pain syndrome that occurs in women and men. Urological pain syndromes in men include Chronic Prostatitis / Chronic Pelvic Pain Syndrome (CPPS).

Chronic pelvic pain has two different definitions:

Historically, chronic pelvic pain (CPP), was defined by the American College of Obstetricians and Gynecologists (ACOG) and applied to women.

In 2009, the European Association of Urology (EAU) published EAU Guidelines on Chronic Pelvic Pain.  Their stated objective was “to revise guidelines for the diagnosis, therapy, and follow-up of CPP patients.”

The European Association of Urologists (EAU) guidelines distinguish between gynecological, gastrointestinal and musculoskeletal pain syndromes in women and men.  

Pelvic pain doctor holding digital tablet
PELVIC PAIN – Doctor holding digital tablet

In the revised guidelines published by the European Association of Urology (EAU) on Chronic Pelvic Pain, they included chapters on chronic prostate pain and bladder pain syndromes, urethral pain, scrotal pain, pelvic pain in gynecologic practice and others. 

ACOG’s Definition of Chronic Pelvic Pain  (CPP)  

The American College of Obstetricians and Gynecologists (ACOG) definition of  chronic pelvic pain.

“Pain lasting for six or more months that localizes to the anatomic pelvis, anterior abdominal wall at or below the umbilicus, the lumbosacral back, or the buttocks and is of sufficient severity to cause functional disability or lead to medical care.  Chronic pain can come and go or it can be constant.” (1)

American College of Obstetricians and Gynecologists, 2011

Chronic Pelvic Pain Continues after a Hysterectomy

“Approximately 12 percent of hysterectomies are performed for pelvic pain and 30 percent of patients who seek treatment at pain clinics have already had a hysterectomy.” (2)

Novak’s Textbook of Gynecology, 12th Ed, 1996

EAU’s Definition of Chronic Pelvic Pain  (CPP)  

The European Association of Urology (EAU) includes both women and men in its definition of chronic pelvic pain and defines chronic pelvic pain as follows (Ref. 2013):

“Chronic or persistent pain perceived in structures related to the pelvis of either men or women.  The pain must be continuous or recurrent for at least six months.” (3) 

European Association of Urology, 2013

Urological Pain Syndromes-Women / Men

When the pain is localized to a single organ, some specialists may wish to consider using an end organ term such as “Bladder Pain Syndrome.”  Urological pain syndromes include bladder pain syndrome, which is often termed as interstitial cystitis.

Angry cartoon bladder
Angry cartoon bladder showing Pelvic Pain

Urological Pain Syndromes in Men

Urological pain syndromes in men include Prostate Pain Syndrome, which is often termed Chronic Prostatitis / Chronic Pelvic Pain Syndrome according to the National Institute of Health (NIH) classification of chronic prostatitis. 

Chronic Prostatitis / Chronic Pelvic Pain Syndrome – NIH Classification

Many researchers use the term Chronic Prostatitis/Chronic Pelvic Pain Syndrome according to the National Institute of Health (NIH) classification of chronic prostatitis.

The National Institutes of Health (NIH) classifies prostatitis into four syndromes.

Prostatitis Syndromes:

  • Acute bacterial prostatitis; 
  • Chronic bacterial prostatitis (CBP) 
  • Chronic nonbacterial prostatitis (CNP) also called Chronic Pelvic Pain Syndrome (CPPS); 
  • Asymptomatic Inflammatory Prostatitis (formerly known as Prostatodynia)

The greatest number of cases of prostatitis have no known cause, despite chronic inflammation (1). 

Meares EM. Prostatitis and Related Disorders.

Chronic Pelvic Pain Syndrome (CPPS)

When the pain is localized to more than one organ site, the term Chronic Pelvic Pain Syndrome (CPPS) should be used.

Chronic Pelvic Pain Syndrome(s) (CPPS) in Women 

business woman pressing on stomach in pain
Close up of young business woman having Chronic pelvic pain in office.

In women, Chronic Pelvic Pain Syndrome (CPPS) includes the following:

  • Vulvar Pain Syndrome (a/k/a vulvodynia)
  • Vestibular Pain Syndrome
  • Clitoral Pain Syndrome
  • Dysmenorrhea
  • Endometriosis 
  • Associated Pain Syndrome 
  • Irritable Bowel Syndrome 
  • Pelvic Floor Muscle Pain Syndrome

The most common musculoskeletal pain syndrome in women is pelvic floor muscle pain syndrome.

Chronic Pelvic Pain Syndrome(s) (CPPS) in Men

3D man with chronic pelvic pain
Chronic Pelvic Pain Syndromes in Men

In men, Chronic Pelvic Pain Syndrome (CPPS) includes the following urological pain syndromes:

  • Scrotal Pain Syndrome
  • Testicular Pain Syndrome
  • Epididymal Pain Syndrome
  • Post Vasectomy Scrotal Pain Syndrome
  • Penile Pain Syndrome
  • Urethral Pain Syndrome 

Many research articles refer to the above-mentioned CPPS syndromes as: 

  • Chronic Orchialgia or 
  • Chronic Scrotal Syndrome  

Prostate Pain Syndrome/Chronic Prostatitis and Chronic Scrotal Pain/Chronic Orchialgia are the most common syndromes male patients complain of.

References

  1. The American College of Obstetricians and Gynecologists (ACOG 2011);
  2. Berek, J., “Novak’s Textbook of Gynecology,” 12th ed., 1996;
  3. European Association of Urology (EAU 2017)