Hormonal Modulation of Genitourinary Pain pp. 109-130
Authors: (Anna P. Malykhina, Gina M. Northington, Division of Urology, Department of Surgery, University of Pennsylvania, Glenolden, Pennsylvania, USA, and others)
Abstract: Genitourinary pain is a common clinical problem that severely affects the quality of life in women and contributes to chronic pelvic pain (CPP). The American College of Obstetricians and Gynecologists (ACOG) has defined CPP in women as localized noncyclic pain of longer than 6 months in duration that leads to a loss of function. Approximately 25-35% of laparoscopies and 10-15% of hysterectomies in the US are
performed to identify a source of CPP.(references needed – Farquhar CM and Steiner CA Obstet Gynecol 2002: 99:229; Howard FM Obstet Gynecol Surv 1993; 48: 357) The range of disorders characterized by CPP is broad and includes gastrointestinal disorders (diverticulosis, inflammatory bowel disease, irritable bowel syndrome, etc.), urologic
disorders (interstitial cystitis, urethral syndrome, chronic calculi, etc.), and gynecologic disorders (endometriosis, vulvodynia, dyspareunia, hydrosalpinx, adhesions, etc.). Many of these disorders do not have discrete pathologic findings that are treatable. The limited understanding of the causes and underlying mechanisms together with the lack of demonstrable pathologic findings and multiple co-morbidities associated with chronic pelvic pain in women suggests a neuroinflammatory component to the development of CPP in women. The presence of specific neuropathic symptoms (burning and tingling pain, site specific allodynia) in patients with multidimensional pelvic pain makes CPP disorders extremely difficult to cure.
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