Wood D P, Wiesner M G, Reiter R C
Department of Obstetrics and Gynecology, Naval Hospital, San Diego, CA 92134.
Clin Obstet Gynecol. 1990 Mar;33(1):179-95. doi: 10.1097/00003081-199003000-00024.
By the time that the pelvalgia patient seeks treatment, her chronic tension, anxiety, stress, and related somatic symptoms, which usually have moderated her fear of repeat assault or punishment by the aggressor-parent, has begun to disintegrate. The patient usually has little or no insight into the fact that her feelings of being trapped, helpless, and victimized in her marriage, job, or other interpersonal relationships can be symbols of the original sexual trauma. The depressed patient may be unaware that suicidal thoughts and actions, if present, are a reflection of her sense of helplessness, hopelessness, and victimization. Hence, CPP may be a symptom of a wide spectrum of disorders, both organic and psychological. While the patient is undergoing evaluation of pelvic pain, it is essential that clinicians remain aware that the patient's psychogenic symptoms are an attempt to reinforce a faltering ego. Additionally, it is important that they recognize that previous attempts at diagnosis and therapy of CPP and other somatic complaints usually have reinforced the belief that the symptoms are physically based and unrelated to any psychological factors. A number of prospective studies currently are underway to characterize further the relationships between complaints of chronic pelvic pain, personality functioning, and history of sexual trauma. Without data on very long-term follow-up, our understanding of the precise psychodevelopmental pathophysiology and long-term prognosis of CPP currently remains incomplete.
当盆腔痛患者寻求治疗时，她长期的紧张、焦虑、压力及相关躯体症状（这些症状通常会缓解她对侵犯性父母再次攻击或惩罚的恐惧）已开始瓦解。患者通常很少或根本没有意识到，她在婚姻、工作或其他人际关系中感到被困、无助和受伤害的感觉可能是最初性创伤的象征。抑郁患者可能没有意识到，如果存在自杀念头和行为，那是她无助感、绝望感和受伤害感的一种反映。因此，慢性盆腔痛可能是多种疾病（包括器质性和心理性疾病）的一种症状。当患者接受盆腔疼痛评估时，临床医生必须意识到患者的心理症状是为了强化摇摇欲坠的自我意识。此外，重要的是他们要认识到，之前对慢性盆腔痛和其他躯体主诉的诊断和治疗尝试通常强化了这样一种观念，即这些症状基于身体原因，与任何心理因素无关。目前正在进行一些前瞻性研究，以进一步明确慢性盆腔痛主诉、人格功能和性创伤史之间的关系。由于缺乏非常长期随访的数据，我们目前对慢性盆腔痛确切的心理发育病理生理学和长期预后的理解仍然不完整。
