This PPT is all about the specific gynecological causes of chronic pelvic pain.

1. Gynecological causes
of chronic pelvic pain
By TEMESGEN GIRMA(C1)
SPHMMC, Addis Ababa, Ethiopia
1

2. Pathophysiology
• The pathophysiology of CPP is unclear in
many patients and may have a significant
association with neuropathic pain.
• Potential gynecologic sources of chronic pain
include
1. Pelvic adhesive disease,
2. Ovarian remnant & retention
syndrome, and
3. Pelvic congestion syndrome
2

3. 1. Pelvic Adhesions
• Adhesions are fibrous connections between
opposing organ surfaces or between an organ and
abdominal wall, at sites where there should be no
connection. They vary in vascularity and thickness.
• Filmy adhesions
• Dense adhesions
3

4. Common Risks for adhesions
• Prior surgery,
• Prior intra abdominal infection
• Endometriosis
• Inflammation from radiation
• Chemical irritation
• Foreign body reaction
4

5. • Adhesions are common, and in laparoscopies
performed for CPP, they are found in approximately
one quarter of cases (Howard, 1993). However, not
all adhesive disease creates pain.
• For example, Thornton and associates (1997) found
no relationship between pelvic pain and women
with intra abdominal adhesions.
5
Cont…

6. Pathophysiology
• Intraperitoneal adhesions are believed to cause
pain when they distort normal anatomy or when
movement stretches the peritoneum or organ
serosa.
• Adhesions that had a relationship to the
peritoneum had a high association with pain.
6

7. Diagnosis
• Laparascopy
• Sonography
Treatment
• Adhesiolysis ,but
appropriate steps
should be taken to
minimize
reformation

8. 2. Ovarian Remnant Syndrome &
Ovarian Retention Syndrome
• Ovarian remnant syndrome (ORS) is a group of
symptoms(pelvic pain, pelvic mass, dyspareunia,
absence of menopause) which arises from a
remnants of an excised ovary.
• ORS is very rare but is most likely to occur among
patients who have had imprecise or incomplete
surgery to remove one or both ovaries.
• Ovarian retention syndrome involves symptoms
stemming from an ovary intentionally left at the time
of previous gynecologic surgery.
8

9. • Women with symptomatic ovarian remnants most
typically complain of chronic
or cyclic pain or dyspareunia. The onset of
symptoms is variable and may begin years following
surgery.
• Risks
Adhesions…… limit Visualization
Anatomic variations
Intraoperative bleeding
Poor surgical techniques….imprecise choice of
surgical site
9
Cont…

10. Diagnosis
• Diagnostic laparascopy
• Clinically
• Laboratory( FSH &
estrdiol)
Treatment
• Therapeutic laparoscopy
or laparotomy(incase of
ureteral adhesion )
• Hormonal therapy
(GnRH agonists,
progesterone)

11. 3. Pelvic Congestion Syndrome
• Pelvic Congestion Syndrome is a group of
symptoms characterized by chronic pelvic
ache, pressure, and heaviness due to a
retrograde blood flow through incompetent
valves of ovarian or pelvic veins.
• The Cause of pain
• Increased dilatation,
• Concomitant stasis, and
• Release of local nociceptive mediators.
11

12. Pathophysiology
• A mechanical dilatation
• An ovarian hormonal dysfunction, or
• Both
• Higher rates of ovarian varicosities and pelvic
congestion syndrome are noted in parous women.
12

13. Diagnosis
• Hx & P/Ex
• Pelvic venography G
Treatment
• Hormonal
• Ovarian vein
embolization(95%
pain improvement)
or ligation, and
• Hysterectomy with
(BSO),

14. Thank you !