Obstetrics and Gynecology Mayo Clinic Health System - Southwest Minnesota region, Mankato, MN, USA.
Physical Medicine and Rehabilitation Mayo Clinic Health System - Southwest Minnesota region, Mankato, MN, USA.
Sex Med Rev. 2022 Oct 1;10(4):529-542. doi: 10.1016/j.sxmr.2022.06.009.
Women with pelvic pain commonly report pain in their ovaries, vagina, uterus, or bladder. These symptoms may be caused by visceral genitourinary pain syndromes but also may be caused by musculoskeletal disorders of the abdomen and pelvis. Understanding neuroanatomical and musculoskeletal factors that may contribute to genitourinary pain is important for evaluation and management.
This review aims to (i) highlight the importance of clinical knowledge of pelvic neuroanatomy and sensory dermatomal distribution of the lower abdomen, pelvis, and lower extremities, exemplified in a clinical case; (ii) review common neuropathic and musculoskeletal causes of acute and chronic pelvic pain that may be challenging to diagnose and manage; and (iii) discuss female genitourinary pain syndromes with a focus on retroperitoneal causes and treatment options.
A comprehensive review of the literature was performed by searching the PubMed, Ovid Embase, MEDLINE, and Scopus databases using the keywords "chronic pelvic pain," "neuropathy," "neuropathic pain," "retroperitoneal schwannoma," "pudendal neuralgia," and "entrapment syndromes."
Retroperitoneal causes of genitourinary pain syndromes have substantial overlap with common conditions treated in a primary care setting. Thus, a comprehensive and systematic history and physical examination, with focused attention to the pelvic neuroanatomy, is key to establishing the correct diagnosis. In the clinical case, such a comprehensive approach led to the unexpected finding of a large retroperitoneal schwannoma. This case highlights the intricacy of pelvic pain syndromes and the complex nature of their possible overlapping causes, which ultimately affects treatment planning.
Knowledge of the neuroanatomy and neurodermatomes of the abdomen and pelvis, in addition to understanding pain pathophysiology, is critical when evaluating patients with pelvic pain. Failure to apply proper evaluation and implement proper multidisciplinary management strategies contributes to unnecessary patient distress, decreased quality of life, and increased use of health care services.
患有盆腔疼痛的女性常报告其卵巢、阴道、子宫或膀胱疼痛。这些症状可能由内脏生殖器疼痛综合征引起，但也可能由腹部和骨盆的肌肉骨骼疾病引起。了解可能导致生殖器疼痛的神经解剖学和肌肉骨骼因素对于评估和管理非常重要。
本综述旨在：(i) 强调临床了解盆腔神经解剖学以及下腹、骨盆和下肢的感觉皮节分布的重要性，通过一个临床病例举例说明；(ii) 回顾常见的神经性和肌肉骨骼性急性和慢性盆腔疼痛的原因，这些原因可能难以诊断和管理；(iii) 讨论女性生殖器疼痛综合征，重点关注后腹膜原因和治疗选择。
通过在 PubMed、Ovid Embase、MEDLINE 和 Scopus 数据库中搜索“慢性盆腔疼痛”、“神经病”、“神经性疼痛”、“后腹膜神经鞘瘤”、“阴部神经痛”和“嵌压综合征”等关键词，对文献进行了全面回顾。
生殖器疼痛综合征的后腹膜原因与在初级保健环境中治疗的常见疾病有很大的重叠。因此，全面系统的病史和体格检查，重点关注盆腔神经解剖学，是确立正确诊断的关键。在临床病例中，这种全面的方法导致了一个大型后腹膜神经鞘瘤的意外发现。该病例突出了盆腔疼痛综合征的复杂性和其可能重叠原因的复杂性，这最终影响了治疗计划。
了解腹部和骨盆的神经解剖学和神经皮节，以及理解疼痛病理生理学，在评估盆腔疼痛患者时至关重要。未能正确应用评估并实施适当的多学科管理策略，会导致患者不必要的痛苦、生活质量下降和医疗服务使用增加。
