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Query: UMLS:C0030794 (pelvic pain)
 4,056 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

One hundred eighty-three women with chronic pelvic pain were referred to a multidisciplinary chronic pelvic pain clinic after negative laparoscopy. One hundred twenty-two of them completed a thorough medical and psychologic evaluation and were followed for a minimum of six months after completion of therapy. Occult somatic pathology was diagnosed in 57 women (47%), including 19 in whom coexistent psychopathology was diagnosed. Myofascial pain was the most common somatic diagnosis, followed by atypical cyclic pain (dysmenorrhea or mittelschmerz); gastroenterologic, urologic and infectious diseases; and pelvic vascular congestion. No plausible somatic etiology was apparent in the remaining 65 (53%) of the 122 referrals. Nongynecologic somatic pathology accounted for 34 (29%) and gynecologic pathology for 23 (19%) of the referrals, only 6 (5%) of whom ultimately required hysterectomy. Women with a somatic diagnosis were found to be significantly older than the remainder of the referral population. Long-term symptomatic improvement or resolution of pain was obtained in 43 (75%) of the 57 patients with somatic diagnoses. Coexistent psychopathology was found to correlate with a poorer long-term prognosis. Our findings underscore the importance of a multidisciplinary approach to evaluating and treating chronic pelvic pain in women and confirm that hysterectomy is indicated in this setting only rarely.
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PMID:Nongynecologic somatic pathology in women with chronic pelvic pain and negative laparoscopy. 183 Jan 2

Chlamydia are a frequent etiologic agent in the chronic salpingitis that has become more and more of a problem in recent years, with its accompanying pelvic pain, ectopic pregnancies, and tubal sterility. Although public health officials, obstetricians and gynecologists, and sexually transmitted disease specialists all agree that prevention would be preferrable to treatment of the resulting tubal lesions and possible neonatal complications, the change of habits necessary for prevention will be difficult to achieve. Infection can be avoided by discouraging early initiation of sexual activity in adolescents, who are apparently particularly susceptible to chlamydial infection, and by discouraging multiple sexual partners since the risk increases appreciably for those having over 3 partners. Condoms and local spermicides with a benzalkonium chloride base offer protection but are poorly accepted by adolescents. IUDs should not be used by adolescents because of the risk of infection. Diagnosis of chlamydia is difficult because about 60% of cases in women are asymptomatic. Persons at high risk because of their patterns of sexual activity should be examined regularly for chlamydia, and tests should be scrupulously performed at all stages and sent to a competent laboratory. All sexual contacts of the chlamydia patient and all their sexual contacts should be treated. An early diagnosis of tubal involvement is difficult but should be pursued through laparoscopy and taking the necessary samples. The public should be educated about the existence, gravity, consequences, and contagiousness of sexually transmitted diseases in such institutions as schools and the military service. Treatment of chlamydia includes early and intensive antibiotic therapy, complete rest, and prolonged use of corticotherapy. An oral contraceptive can be prescribed to prevent development of functional ovarian cysts. Laparoscopic control is essential to ensure that the cure was effective. Return of the infection is associated with a very poor prognosis.
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PMID:[Prevention of Chlamydia trachomatis infections in women]. 652 58

Infection with Chlamydia trachomatis can be either symptomatic or asymptomatic. In adults, complications include infertility, chronic pelvic pain and ectopic pregnancy. Complications in newborns include conjunctivitis and pneumonia. Screening of asymptomatic women at high risk for the disease can identify candidates for antibiotic therapy. Until recently, chlamydia cell culture was the only diagnostic test and it was not widely available. Because the specificity of cell culture is 100 percent, it remains the standard against which other tests are measured. The recent development of nonculture tests makes it feasible for most laboratories and physicians' offices to offer testing. The main disadvantage of nonculture tests is low specificity. A positive screening test in a woman at low risk should be confirmed by a second test. Routine screening and treatment of patients who are at high risk can decrease the incidence, complications and transmission of chlamydial infection.
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PMID:Screening for Chlamydia trachomatis infection. 760 79

Pelvic inflammatory disease (PID) is the must important gynecologic infectious disease. It causes not only serious clinical symptoms, life threatening complications, but also severe damage to the female upper reproductive tract. Among its important sequale are infertility due to tubal occlusion, ectopic pregnancy, dyspareunia, and chronic pelvic pain. The must important causative organisms are Neisseria gonorrhoeae, Chlamydia trachomatis, as well as anaerobic and facultative bacteria found in the vaginal flora of women with bacterial vaginosis. The author reviews the latest developments regarding the epidemiology, etiology diagnostics, medical and surgical therapy of the disease. The importance and possibilities of prevention are discussed.
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PMID:[Inflammation of the pelvis minor]. 975 75

The chronic prostatitis syndrome is a multifactorial disease of mainly unknown etiology. Quite different therapeutic options are therefore recommended. According to the new NIH classification only in acute and chronic bacterial prostatitis pathogens can be cultured. A long-term antimicrobial therapy, mainly with fluoroquinolones, is therefore recommended. Most of the patients, however, suffer from a chronic pelvic pain syndrome (CPPS) which can be subdivided into an inflammatory and a non-inflammatory CPPS. Whether the inflammatory CPPS is an infectious disease, remains uncertain. An antibiotic therapy therefore is not the first choice. Several patients, however, have been improved by such a therapy, especially in combination with alpha-receptor blockers. In case of proven or suspected functional obstruction of the bladder neck long-term treatment with relatively high dosages of alpha-receptor blockers is recommended. In case of failure other treatment modalities, including psychosomatics, may be applied, of which usually only results of sporadic reports but not of controlled studies are available. It is important, however, to keep the patient fully informed about the diagnostic and therapeutic problems not to interfere with a trustful therapist-patient relationship.
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PMID:[Therapy of prostatitis syndrome]. 1122 26

The first step in adopting a practical approach to the management of patients with prostatitis lies in the realization that the etiology of the symptoms often remains unclear and the traditional etiologically based classification system is part of the problem and not the solution. This problem was recognized in 1995 by the National Institutes of Health Consensus Conference on prostatitis. It was suggested that the classification of this disease be changed. The traditional categories "chronic nonbacterial prostatitis" and "prostatodynia" were replaced by the new category "chronic pelvic pain syndrome." The introduction of the term "syndrome" reflects two issues: despite lack of evidence for bacterial involvement based on conventional methods, nonbacterial prostatitis may indeed still be an infectious disease, and the etiology of the symptoms may be caused by a disorder not related to the prostate gland alone.
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PMID:[Etiopathogenesis of prostatitis]]. 1122 30

Prostatitis reflects a broad spectrum of prostatic infections, both acute and chronic. Chronic prostatitis, known as National Institutes of Health category III or chronic pelvic pain syndrome, broadly defines a disease that is still poorly understood, and as a consequence, difficult to treat. Typical symptoms include pelvic pain and voiding dysfunction. Infection is often cited as the cause of this condition, despite frequent negative cultures. A close look at the local prostatic microenvironment may yield clues. The role of inflammatory mediators and what stimulates them can point to potential sites of prevention. A genetic link or relationship to other diseases may prove to be part of the cause. Furthermore, a neurologic source, whether anatomic or psychologic, has been strongly debated. Ultimately, it may become clear that chronic prostatitis represents the final common result of a disease that originates from a cascade of multiple stimuli.
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PMID:Theories of prostatitis etiology. 1214 62

Intrauterine devices (IUDs) have been under much adverse media publicity and many product liability lawsuits have been filed since the mid-1970s, when reports of the association of the Dalkon Shield with septic abortion and pelvic inflammatory disease (PID) surfaced. Yet, worldwide, it is estimated that 70 million women are using IUDs (50 million in China). In Scandinavia they are the most popular form of contraception. An international meeting on the current status of IUDs in New York in 1992 concluded that the IUD is a safe and excellent method of contraception for many women. The newest devices, such as Copper TCu380A and the Multiload Cu375, are the most effective. The risk of PID compared with women using no contraception is elevated by a factor of 7.02 only within the first 20 days after IUD insertion. In Norway, where around 40% of women use IUDs, there has been no increase in subfertility rates compared with the US and UK. A large WHO multicenter study in 1989 found that IUD users were 50% less likely to experience ectopic pregnancy than women using no contraception (90% with Copper TCu 380A). The risk of spontaneous abortion is more than doubled and the risks of preterm delivery increased 10-13% with an IUD in situ; therefore, IUDs should be removed as soon as pregnancy is confirmed. If uterine perforation by the device is suspected, it should be located by ultrasound or x-ray and promptly removed. After contraceptive counselling, even experienced general practitioners can insert IUDs at any time during the menstrual cycle, after induced abortion, or complete spontaneous abortion. Heavy menstrual loss or dysmenorrhea are the most common reasons for removing IUDs. Partial or complete IUD expulsion by uterine contractions is most likely during the first 3 months after insertion. Infection should be suspected in any user who develops pelvic pain.
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PMID:IUDs: current perspectives. 1231 52

Almost 10% of the adult male population suffer from prostatitis. The International Prostatitis Collaborative Network has devised and validated a clinically useful classification of prostatitis that urologists and primary care clinicians will find helpful. According to this schema, chronic bacterial prostatitis is clearly an infectious disease, and patients with chronic prostatitis associated with chronic pelvic pain syndrome can have either inflammatory or noninflammatory disease. Chronic bacterial prostatitis is uncommon, chronic nonbacterial prostatitis (CPPS) is extremely common. Antibiotic therapy is indicated in management of chronic bacterial prostatitis and inflammatory chronic pelvic pain syndrome. Fluoroquinolones are safe and effective in managing chronic bacterial prostatitis. Based on literature, noninflammatory chronic pelvic pain syndrome can be treated using adrenergic blockade, analgesic, tricyclic antidepressants, benzodiazepie, physical therapy.
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PMID:[Chronic prostatitis with chronic pelvic pain syndrome]. 1255 33

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is the most common of the prostatitis syndromes. It is characterised by pelvic pain, with or without voiding symptoms. CP/CPPS accounts for 2 million office visits in the US alone. Recent epidemiological studies have shown that CP/CPPS can affect men at any age, including those in their 80s. The aetiology is unknown but proposals include infectious, autoimmune, neurologic and psychiatric causes. Men with CP/CPPS are much more likely to have had a past medical history of cardiovascular, neurologic, psychiatric or infectious disease (particularly sinusitis) as compared with asymptomatic individuals. Although leucocytes are commonly found in the prostatic fluid of these men, they do not correlate with the symptoms. The clinical evaluation now includes a validated, self administered symptom score, the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), which was designed as an outcome measure for treatment trials. This can aid in diagnosis and follow-up of patients' response to therapy. Treatment for CP/CPPS is empiric and limited by a lack of randomised, placebo-controlled clinical trials. Antimicrobials are commonly used to treat the symptoms of CP/CPPS. However, the finding that asymptomatic men have equal or greater numbers of bacteria which localise to the prostatic fluid, compared with men with CP/CPPS, has raised doubts about the contribution of infection to the symptoms. Other commonly used drugs include alpha-adrenoceptor antagonists, anti-inflammatory drugs, tricyclic antidepressants and anticholinergic agents. The adverse effects of these medications are a concern in older men with CP/CPPS. Other therapies available include minimally invasive procedures such as microwave thermotherapy and transurethral needle ablation, and now neuromodulation devices.Although much progress has been made, particularly in the last 7 years, considerable work still remains to be done to determine the aetiology and pathogenesis of CP/CPPS, and to develop mechanism based therapy that is shown to be effective in controlled trials.
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PMID:Chronic prostatitis/chronic pelvic pain syndrome in elderly men: toward better understanding and treatment. 1465 34


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