Definitions of chronic pelvic pain terminology

posted on 17th September 2011 by Stefan Chmelik

Guidelines on Chronic Pelvic Pain (2009)
M. Fall (chairman), A.P. Baranowski, S. Elneil, D. Engeler,
Hughes, E.J. Messelink, F. Oberpenning, A.C. de C. Williams

2.2 Definitions of chronic pelvic pain terminology

Chronic pelvic pain: Non-malignant pain perceived in structures related to the pelvis of either men or women. In the case of documented nociceptive pain that becomes chronic, pain must have been continuous or recurrent for at least 6 months. If non-acute and central sensitization pain mechanisms are well documented, then the pain may be regarded as chronic, irrespective of the time period. In all cases, there often are associated negative cognitive, behavioural, sexual and emotional consequences (5,6)

Pelvic pain syndrome: Persistent or recurrent episodic pelvic pain associated with symptoms suggesting
lower urinary tract, sexual, bowel or gynaecological dysfunction. No proven infection or other obvious pathology (adopted from ICS 2002 report) (1)

Bladder pain syndrome: Suprapubic pain is related to bladder filling, accompanied by other symptoms such as increased daytime and night-time frequency. There is an absence of proven urinary infection or other obvious pathology. This term has been adopted from the ICS 2002 report (1), where the term painful bladder syndrome was used; the name has been changed to bladder pain syndrome to be consistent with other pain syndrome terminology (5,6). The European Society for the Study of IC/PBS (ESSIC) publication places greater emphasis on the pain being perceived in the bladder (4)

Urethral pain syndrome: Recurrent episodic urethral pain, usually on voiding, with daytime frequency and nocturia. Absence of proven infection or other obvious pathology (1)

Penile pain syndrome: Pain within the penis that is not primarily in the urethra. Absence of proven infection or other obvious pathology (5,6)

Prostate pain syndrome: Persistent or recurrent episodic prostate pain, associated with symptoms suggestive of urinary tract and/or sexual dysfunction. No proven infection or other obvious pathology (5,6)
Definition adapted from the National Institutes of Health (NIH) consensus definition and classification of prostatitis (7) and includes conditions described as ‘chronic pelvic painsyndrome’. Using the NIH classification system, prostate pain
syndrome may be subdivided into type A (inflammatory) and type B (noninflammatory)

Scrotal pain syndrome: Persistent or recurrent episodic scrotal pain associated with symptoms suggestive of urinary tract or sexual dysfunction. No proven epididymo-orchitis or other obvious pathology (1)

Testicular pain syndrome: Persistent or recurrent episodic pain localized to the testis on examination, which is associated with symptoms suggestive of urinary tract or sexual dysfunction. No proven epididymo-orchitis or other obvious pathology. This is a more specific definition than scrotal pain syndrome (1)

Post-vasectomy pain syndrome: Scrotal pain syndrome that follows vasectomy (1)

Epididymal pain syndrome: Persistent or recurrent episodic pain localized to the epididymis on examination.
Associated with symptoms suggestive of urinary tract or sexual dysfunction. No proven epididymo-orchitis or other obvious pathology (a more specific definition than scrotal pain syndrome (5,6)

Endometriosis-associated pain syndrome: Chronic or recurrent pelvic pain where endometriosisis present but does not fully explain all the symptoms (5,6)

Vaginal pain syndrome: Persistent or recurrent episodic vaginal pain associated with symptoms suggestive of urinary tract or sexual dysfunction. No proven vaginal infection or other obvious pathology (1)

Vulvar pain syndrome: Persistent or recurrent episodic vulvar pain either related to the micturition cycle or associated with symptoms suggestive of urinary tract or sexual dysfunction. There is no proven infection or other obvious pathology (1)

Generalized vulvar pain syndrome (formally dysaesthetic vulvodynia): Vulval burning or pain that cannot be consistently and tightly localized by point pressure ‘mapping’ by probing with a cotton-tipped applicator or similar
instrument. The vulvar vestibule may be involved but the discomfort is not limited to the vestibule. Clinically, the pain may occur with or without provocation (touch, pressure or friction) (8)

Localized vulvar pain syndrome: Pain consistently and tightly localized by point-pressure mapping to one or more
portions of the vulva. Clinically, pain usually occurs as a result of provocation (touch, pressure or friction) (8)

Vestibular pain syndrome (formerly vulval vestibulitis): Pain localized by point-pressure mapping to one or more portions of the vulval vestibule (8)

Clitoral pain syndrome: Pain localized by point-pressure mapping to the clitoris (8)

Anorectal pain syndrome: Persistent or recurrent, episodic rectal pain with associated rectal trigger points/tenderness related to symptoms of bowel dysfunction. No proven infection or other obvious pathology (5,6)

Pudendal pain syndrome: Neuropathic-type pain arising in the distribution of the pudendal nerve with symptoms and signs of rectal, urinary tract or sexual dysfunction. No proven obvious pathology (5,6). (This is not the same as the well-defined pudendal neuralgia)

Perineal pain syndrome: Persistent or recurrent, episodic, perineal pain either related to the micturition cycle or associated with symptoms suggestive of urinary tract or sexual dysfunction. No proven infection or other obvious pathology (1)

Pelvic floor muscle pain syndrome: Persistent or recurrent, episodic, pelvic floor pain with associated trigger points,
which is either related to the micturition cycle or associated with symptoms suggestive of urinary tract, bowel or sexual dysfunction. No proven infection or other obvious pathology (5,6)

Full list of terms for Chronic Pelvic Pain Syndrome:

Interstitial cystitis (IC)
Pelvic Floor Dysfunction (PFD)
Vestibulitis, vulvodynia, clitorodynia, vaginismus, prostatodynia
Non-bacterial cystitis or prostatitis
Reproductive pelvic pain
Dyspareunia
Bladder pain syndrome/interstitial cystitis (BPS/IC)
Overactive Bladder Syndrome (OBS)
Irritable Pelvis Syndrome (IPS)
Urgency-Frequency Syndrome (UFS)
Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS )
Prostate Pain Syndrome (PPS)
Painful Bladder Syndrome (PBS)
Endometriosis Associated Pain Syndrome
Urethral Pain Syndrome
Penile Pain Syndrome
Scrotal Pain Syndrome
Vaginal Pain Syndrome
Vulvar Pain Syndrome
Pudendal Pain Syndrome
Vestibular Pain Syndrome
Clitoral Pain Syndrome
Epididymal Pain Syndrome
Post-vastectomy Pain Syndrome
Perpetual Arousal Syndrome (PAS)

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In December 2012, as result of a stress at work, I suffered from severe anxiety, fear, panic attacks, tachycardia and insomnia.These symptoms became increasingly severe and were associated with low self-esteem and loss of self-confidence. I consulted my GP who prescribed Citalopram and beta blockers for the tachycardia. The antidepressant did not suit me and I felt worse. I was then referred to Dr Brian Kaplan, to be treated with the ‘Provocative Therapy’. This treatment adapted by Dr Kaplan, is based on the principle that the therapist ask questions covering all aspects of the patient’s life, by exaggerating the meanings of it. During the 1 hour session, the patient experiences a strong reaction, triggered by the ‘Provocative’ input of the therapist. Initially, there is an increased fear with regression to the childhood, associated to strong emotions and sorrow, which may precipitate sobbing. Subsequently, this state is followed by a phase of self-analysis which is more constructive. The ‘provocation’ breaks the pattern of the patient’s own feelings of hopelessness and discomfort. In fact, there is an opening of the self-image and a critical strong desire for change, in response to the provocation, which can be at times, outrageous. I underwent 9 weekly sessions during which I progressively became free from fear. The anxiety and panic attacks reduced significantly and I started to know what I want from my life and became more positive and optimistic. At the end of the 9 weeks, I acquired my self-confidence and self – esteem together with a new approach in my life which initially appeared to me broken and rather useless. The 9 sessions – in my opinion – were sufficient to resolve the initial acute state with anxiety and I felt a person full of interest and happier. It is more than one year since I started the ‘provocative therapy’ with Dr Kaplan and I have not had any relapse to the original symptoms and discomfort. I strongly recommend this this therapy as a novelty; this is medication- free and can produce resolution of the acute psychological/mental conditions, quicker than the conventional therapies. In order to be successful, it is crucial that the patient collaborates and has complete trust in the therapist. The scientific process of such a treatment is not yet known and /or clarified. However, a number of recent studies in Neurophysiology and Psychiatry have shown the importance of hexogen and endogen stimuli, which can triggers and induce changes in the brain in response to the external inputs, acting via the hypothalamic/endocrine axes. It can be suggested that some of these mechanisms may be involved in the therapeutic process of the Provocative Therapy, but a lot of work needs to be in hand.