Chronic pelvic pain has two different definitions

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).

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 Guidelines on chronic pelvic pain (CPP).  Their stated objective was “to revise guidelines for the diagnosis, therapy, and follow-up of CPP patients.”

The EAU guidelines distinguish between gynecological, gastrointestinal and musculoskeletal pain syndromes in women and men.  The revised guidelines published by the EAU on CPP include 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.

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 E.M., 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 

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

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)

Author: Melanie Loomos

I was a court reporter for 10 years and spent most of my time in very uncomfortable chairs. As a result, I spent years researching seating and submitted two patent applications: "The Carpal Tunnel Chair,” and "The Pillow with Cantilever Supports.," The Buttpillow® has several configurations so you can find the best cushion for your workstation. For example, Gamers need a rearward tilt if they lean back & coders typically need a forward sloping cushion. The Buttpillow® was improved upon as it was determined different embodiments were needed for proper ergonomic positioning depending on the individual sitter. The Patented "Ergonomic Seating Cushion,” was was granted by the USPTO; and was later amended to include an embodiment specifically to help women maintain the natural curve of their lumbar spine during the second and third trimester of pregnancy. An extreme lumbar curve that restricts blood flow to the fetus is the only external risk factor for low birth weight babies. In 2003, I invented Ergosoft™ break reminder software based on OSHAs Ergonomic Standard so people can identify and minimize ergonomic risk factors for the development of sitting-related pain, eye strain, DVT and carpal tunnel syndrome.

Leave a Reply

This site uses Akismet to reduce spam. Learn how your comment data is processed.

%d bloggers like this: