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What Is Chronic Pelvic Pain Syndrome (CPPS)?

by Allyson Augusta Shrikhande, MD, CMO

Each May marks an annual observance highlighting an issue that is very important to me: it’s Pelvic Pain Awareness Month, dedicated to encouraging greater understanding of pelvic pain disorders. The pelvis is located at the literal center of the anatomy and the way that it functions relates directly to so many systems of the body. Given its critical role, pelvic health merits a lot more focus and understanding than it often seems to receive. With that in mind, I want to talk a little bit about Chronic Pelvic Pain Syndrome (CPPS), a condition which affects up to 20% of women between the ages of 18 and 50, and which is often treatable.

What is chronic pelvic pain syndrome?

Chronic Pelvic Pain Syndrome describes pain or discomfort in the lower abdominal and pelvic region, including the buttocks, lower back, hips, groin, perineum, and deep pelvic structures which lasts for more than six months. The symptoms of CPPS often affect function of other areas such as bladder, bowel and intercourse. It can cause difficulty sleeping and pain with sitting or sexual intercourse, and can cause mobility issues which can impede your ability to manage basic daily tasks. The symptoms of CPPS should be taken seriously and deserve the attention of a healthcare professional.

What are the causes and risk factors that can lead to CPPS?

CPPS can have a range of different factors and is often caused by a confluence of multiple root problems. Some of the most common risk factors are:

  • Gynecological disorders such as endometriosis, adenomyosis, fibroids, polycystic ovarian syndrome, pelvic inflammatory disease, pelvic congestion syndrome, vulvodynia, and lichen sclerosus

  • Recurrent infections such as yeast infections, urinary tract infections, and bacterial vaginosis

  • Hormonal changes which either occur naturally throughout a woman’s lifetime or due to a glandular imbalance

It’s also important to consider how mental factors, such as stress, anxiety, and emotional trauma may cause tension in the muscles of the pelvic floor. It is also possible that there is a hereditary tendency for the nervous system to be hyperactive, causing increased sensitivity.

Why is CPPS so difficult to diagnose?

CPPS is a complex condition which often involves multiple organs as well as the nervous, myofascial, and skeletal systems. Some of the most prevalent risk factors for CPPS, such as endometriosis or neuromuscular dysfunction, are very challenging to diagnose as the issue may not always be apparent on x-rays, ultrasounds or other common imaging tests. It takes a specialist in pelvic pain making informed analysis based on a patient’s medical history and symptoms to properly identify CPPS.

How does CPPS affect a woman’s sex life?

CPPS can have devastating affects on a patient’s sex life. It can cause pain during intercourse which ranges from a superficial burning sensation to pain with deep penetration. This pain may occur every time penetration occurs, or just in certain positions. CPPS can also cause post-intercourse pain, soreness, or bladder symptoms. For some patients, the pain is so severe that they stop having intercourse altogether.

What can be done to treat CPPS?

The key to a good treatment for CPPS is properly identifying the underlying causes and predisposing conditions and addressing each one of them. It is important to take a multidisciplinary approach as CPPS is often not best treated by one specialty alone. As physiatrists, we are trained in not just the workings of one organ system, but the interaction between all of them, making us ideally qualified to take point on the treatment of this serious chronic condition, but a well-equipped team to treat CPPS should also include an OBGYN, pelvic floor physical therapist, pain psychologist, and in some cases, experts in disciplines such as holistic nutrition, integrative medicine, urology, or acupuncture.

What are the signs that a woman should see a doctor?

Pelvic pain is not normal and you should talk to your doctor if you are experiencing any pain or discomfort in the lower abdomen or pelvis. You should also report any of the following symptoms such as pain with intercouse, urinary urgency/frequency, nocturia (inability to sleep through the night without urinating), bladder pain, and painful urination or bladder filling, or pain with bowel movements. You deserve to enjoy your life, and any pain that affects your ability to sit for long periods, handle daily tasks, or attend to obligations for school, work, or your social life should be addressed by a medical professional.

Dr. Allyson Shrikhande, a board certified Physical Medicine and Rehabilitation specialist, is the Chief Medical Officer of Pelvic Rehabilitation Medicine. A leading expert on pelvic health and a respected researcher, author and lecturer, Dr. Shrikhande is a recognized authority on male and female pelvic pain diagnosis and treatment.