Revolutionizing Gynaecologic Pain Management: Exploring Modern Trends and Innovations

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Review

HJOG 2025, 24 (2), 110-125| doi: 10.33574/hjog.0591

Vinaya Vijayan1, Maya Savira2, Rajkumar Krishnan Vasanthi3, Challaraj Emmanuel ES4, Muthu Prasanna5, Sovan Bagchi6

1Department of Physiology, Apollo Institute of Medical Sciences and Research, Jubilee Hills, Film Nagar, Hyderabad, Telangana 500090, India.
2Department of Physiology, Faculty of Medicine, Universitas Sumatera Utara, Indonesia
3Faculty of Health and Life Sciences, INTI International University, Nilai, Negeri Sembilan, Malaysia.
4Department of Life Sciences, Kristu Jayanti College (Autonomous), K Narayanapura Kothanur Post, Bengaluru-560077 Karnataka, India.
5Department of Pharmaceutical, Biotechnology, Surya College of Pharmacy, India.
6Department of Biomedical Sciences, College of Medicine, Gulf Medical University, UAE.

Correspondence: Sovan Bagchi, Professor, Department of Biomedical Sciences, College of Medicine, Gulf Medical University, UAE. Orcid ID: 0000-0003-3507-1944

Abstract

Gynaecologic pain management remains a neglected aspect of women’s healthcare despite significant advancements in obstetrics. Chronic pelvic pain (CPP), affecting 7 to 24% of the population, leads to diminished quality of life and substantial healthcare costs. Identifiable biological conditions account for some cases of CPP, but when the cause is elusive, it poses challenges for patients and clinicians. Neuropelveology, an interdisciplinary approach to identifying pelvic nerve pathologies, offers insights into CPP beyond gynecology. Neuropathic pelvic pain, characterized by sensory nerve dysfunction, presents diagnostic challenges due to its diverse manifestations and overlaps with other abdominal/pelvic pain conditions. Clinical examination remains crucial for accurate diagnosis, surpassing reliance on imaging techniques. Management often involves multidisciplinary strategies, including centrally-acting neuromodulator medications. This review encompasses various gynecologic conditions contributing to pelvic pain, including endometriosis, adenomyosis, dysmenorrhea, fibroid pain, ovarian cysts, vulvodynia, interstitial cystitis, and pelvic organ prolapse. It emphasizes the importance of gynecological examinations in promptly identifying and managing these conditions, aiming to improve women’s reproductive health and quality of life. It discusses fertility treatments, STI screening, menstrual disorders, and gynecological surgeries, providing comprehensive insights into women’s healthcare needs.

Keywords: Pelvic pain management, Chronic pelvic pain, Neuropathic pain diagnosis, Gynaecologic pain assessment, Women’s reproductive health

Introduction­

Advances in modern obstetrics have undoubtedly improved labour management through the integration of pain medication, but gynecologic pain management remains comparatively neglected. Chronic pelvic pain  (CPP) affects a significant portion of the population, ranging from 7 to 24 %, leading to diminished quality of life and considerable healthcare expenses.(1) Commonly reported complaints include perineal or genital pain, coccygeal and perianal, often stemming from identifiable organic conditions such as anal fistulae, infections, or hemorrhoids.(2) However, when CPP lacks an apparent cause, it presents a formidable challenge for patients and clinicians, necessitating a broader understanding beyond gynecology. Proficiency in pelvic neuroanatomy and clinical neurology becomes imperative in such cases. This interdisciplinary approach, known as neuropelveology, specializes in identifying pathologies and nerve-related injuries in the pelvic region and contributes to the understanding and treating of CPP beyond the gynaecological realms.(3) The International Association for the Study of Pain’s Neuropathic Pain Special Interest Group defines neuropathic pain as a condition that stems from lesions or diseases affecting the nervous system’s sensory component.(4) Words like “electric shock,” “dull,” “itching,” and “burning” describe this pain.(5) The challenge lies in definitively confirming neuropathic pain, leading to guidelines grading it as “definite,” “probable,” or “possible.” Women often encounter abdominal/ pelvic issues, potentially causing probable neuropathic pain. Surgical procedures, such as cesarean or vaginal delivery, may lead to chronic pain (10–20%), with Gynaecologic procedures posing a risk of 5–32%.(6) Gender-specific physiological processes and neuroanatomical variances might explain women’s higher risk of chronic pain post-surgery, often reflecting neuropathic pain components.(7) The complexity of diagnosing pelvic neuropathic pain is compounded by various abdominal/pelvic pain differential diagnoses. Clinical examination remains key for reliable neuropathic pain detection, surpassing reliance on other diagnostic methods (electrical, magnetic resonance, x-ray, etc.).(8) Tissues exhibit diverse innervation by sensory fibers, processing different painful stimuli through distinct sensory fiber types. Acute pelvic pain often presents with additional nonspecific symptoms like nausea, vomiting, and leukocytosis.(9) Endovaginal ultrasound (EVUS) is the preferred initial imaging method when there’s suspicion of obstetric or gynaecologic origins.(10) CPP, defined by noncyclic discomfort persisting beyond six months, commonly stems from gynecologic conditions like adenomyosis, endometriosis, leiomyomas, adhesions, and pelvic congestion syndrome.(11) Ultrasound (US) is a valuable tool for diagnosing leiomyomas, adenomyosis, and endometriosis.(12) The primary principle in diagnosing neuropathic pain involves acknowledging its involvement in alterations within the central nervous system, not solely peripheral tissues. A corollary to this principle is that neuropathic pain impacts sleep and mood, necessitating therapies to address broader brain-related issues to enhance quality of life. Patients demonstrating central sensitization may require treatment with centrally acting neuromodulatory medications despite presenting symptoms suggesting a peripheral issue.(13) These medications, often labeled for antidepressant, anticonvulsant, and sedative-hypnotic use, can effectively manage neuropathic pain.(14) This comprehensive review focuses on Gynaecological health topics essential to women’s well-being. From neuropathic pelvic pain to fertility treatments, each aspect is reviewed and covers acute pelvic pain, endometriosis, fibroid pain, and ovarian cysts, offering insights into diagnosis and management. The review explores dysmenorrhea, vulvodynia, and interstitial cystitis, reviving on often overlooked conditions. Moreover, it discusses critical areas such as pelvic organ prolapses, birth control management, STI screening, menstrual disorders, and Gynaecological surgeries, substantiating an understanding of women’s health needs.

Neuropathic pelvic pain and Gynaecological examination

Prior pelvic or abdominal surgery, as well as obstetric occurrences, are important risk factors. Inguinal hernia repair, low abdominal trocar or drainage incisions, and Pfannenstiel incisions all have the potential to cause damage to the genitofemoral and ilioinguinal nerves.(15) Interventions involving the perineum, rectum, or obstetrics may cause injury to the pudendal nerve and its branches.(16) Furthermore, pelvic operations and thrombosis can disrupt pelvic vein circulation, potentially leading to pelvic varicose veins and increasing the risk of vascular entrapment or sacral compartment syndrome.(17,18) Patients with varicose veins are more likely to develop pelvic varicose veins. Clinical examination consists of checking the genital organs using methods such as colposcopy, (19) which is supplemented by vaginal culture, urinalysis, vaginal pH testing, Pap smear, and biopsy of abnormal vulvar regions. Rectovaginal palpation goes beyond the parametria and rectovaginal space to evaluate the pudendal and low sacral nerve roots.(20) Although sacral nerve roots L5 and S1 cannot be reached by vaginal or rectal palpation, the pudendal nerve can be palpated dorsomedial to the sciatic spine, and the low sacral nerve roots can be reached at the sacrum bone, a few millimeters left and right of the midline. Abdominopelvic neuropathic pain is frequently found after surgery. Beyond this period, gynecologists often see neuropathic pain in uncommon cases, such as when endometriosis affects pelvic nerves or spontaneous pain compresses nerves such as the obturator, pudendal, or lateral femoral cutaneous branches. Neurologists should be consulted in more common fascial or distal extremities neuropathies. A detailed surgical history, particularly past transverse abdominal incisions, is critical for discomfort after Gynaecologic operations since they can jeopardize nerves such as iliohypogastric, ilioinguinal, and genitofemoral.(21) Gynecologists normally test mechanical sensitivity, but they should also include changes in heat sensitivity caused by neuropathy.

Acute pelvic pain

Acute pelvic discomfort in women can be caused by a variety of gynecologic reasons, which are classified as obstetric or nonobstetric.(22) As a result, when evaluating premenopausal women with abrupt pelvic discomfort, it is critical first to determine pregnancy status, which is frequently done by measuring human chorionic gonadotropin (hCG) levels.(23) Nonpregnant persons may have pelvic pain due to large ovarian cysts, rupture cysts, pelvic inflammatory disease (PID), ovarian torsion, or misplaced intrauterine devices.(24) Pregnant women may have discomfort as a result of issues such as hemorrhagic corpus luteums (CL), ectopic pregnancies (EP), or problems such as ovarian hyperstimulation syndrome (OHSS) and degenerated fibroids.(25) Endometritis, retained products of conception (RPOCs), ovarian vein thrombophlebitis, or uterine rupture can all cause postpartum pelvic pain. More than two-thirds of advanced-stage cancer patients endure significant pain, with up to half reporting inadequate pain management.(26) This trend extends to Gynaecologic oncology patients, who often experience acute pain due to disease progression or cancer therapies. The severity of pain does not always align with tumor size, as different cancers vary in their capacity to cause tissue damage and trigger pain-related responses.(27) In the cancer microenvironment, communication among neoplastic cells, the immune system, and the nervous system increases pain signaling.(28) Recognizing pain’s multifaceted nature, tailored pain management plans for Gynaecologic oncology patients should integrate various disciplines and treatments, including both pharmacological and non-pharmacological approaches. Surgery constitutes a significant aspect of Gynaecologic cancer treatment. While surgery alone can be curative for some patients, others may experience post-operative pain to varying degrees. Surgical teams are responsible for ensuring adequate pain relief, traditionally relying on opioids. Pre-surgery discussions should establish realistic pain management goals, emphasizing comfort and early mobility over complete pain elimination.

Endometriosis and adenomyosis

Pelvic neuropathies often accompany prevalent pelvic conditions like uterine myomas, ovarian issues, retroperitoneal vascular irregularities, fibrosis in the retroperitoneum, and neurogenic tumors.(29,30) Conversely, sacral radiculopathy commonly arises from surgical injury, deep-seated endometriosis along the pelvic sidewall, and nerve compression or entrapment due to pelvic varicose veins. Endometriosis, characterized by endometrial tissue beyond the uterus, may occur on the ovary, uterine ligaments, or peritoneal surfaces. It’s an estrogen-dependent inflammatory condition affecting 5% to 15% of women of reproductive age, characterized by the abnormal growth of endometrial stroma and glands.(31) Its key clinical manifestations include dysmenorrhea, CPP, and infertility. Endometriosis, a chronic and recurrent ailment, significantly impacts the quality of life among women in their reproductive years. Changes in lifestyle, like delayed marriage and fewer children, are believed to contribute to the increasing incidence of endometriosis, as they lead to more frequent menstruation cycles. Areas less commonly affected include the vagina, bladder, cervix, cesarean section scars, abdominal scars, or the inguinal ligament.(32) When subjected to hormonal changes, displaced endometrial tissue undergoes repetitive bleeding cycles, absorption, and fibrosis, forming endometriomas, scarring, and adhesions.(33) Factors that contribute to endometriosis comprise shorter menstrual cycles, extended menstrual flow, intermenstrual bleeding, and the use of hormone replacement therapy. Symptoms manifest in approximately half to 80% of patients, comprising dysmenorrhea, abnormal uterine bleeding, painful intercourse, infertility, and persistent pelvic discomfort.(34) Endometriosis, a condition influenced by hormones, typically manifests cyclic pain linked to the menstrual cycle, with pain severity unrelated to the visible extent of the disease. EVUS plays a crucial role in diagnosing endometriomas, revealing a unique presentation featuring a single-chambered cyst with uniform low-level echoes and increased transmission. Adenomyosis, distinguished by the existence of endometrial glands within the uterine myometrium, frequently exhibits symptoms such as irregular uterine bleeding, dysmenorrhea, and infertility, mirroring other ailments like endometriosis or leiomyomas.(35) Its diagnosis remains challenging due to nonspecific signs, with ultrasound analysis revealing varied features like uterine enlargement, heterogeneous myometrium, and occasionally, focal adenomyomas displaying vascularization and even cystic formations. Adenomyosis is identified by the existence of endometrial glands and stroma within the myometrium, frequently resulting in dysmenorrhea and abnormal uterine bleeding (AUB).(36) It stands as a prevalent cause of AUB. Confirmation of diagnosis involves transvaginal ultrasonography and magnetic resonance imaging. Identifying adenomyosis features through imaging aids in diagnosis, particularly when linked with symptoms like menstrual pain, heavy bleeding, and infertility, thus supporting the diagnostic process.(37) Both Endometriosis and Adenomyosis can lead to excruciating menstrual cramps, pelvic pain, and discomfort during intercourse. Managing this pain often requires a multidisciplinary approach, including pain medications, hormone therapy, lifestyle changes, and sometimes surgical intervention. Nonsteroidal anti-inflammatory drugs (NSAIDs) may alleviate mild to moderate pain, while hormonal treatments like birth control pills or gonadotropin-releasing hormone agonists aim to regulate hormones and reduce symptoms.38 In severe cases, surgical options such as laparoscopy or hysterectomy may be considered to provide relief. (Figure 1).

Figure 1. Treatment for Endometriosis and Adenomyosis.

Dysmenorrhea

Dysmenorrhea, characterized by painful menstruation, impacts a significant portion, ranging from 50% to 90%, of adolescent girls and women in their reproductive years.(39) Around 45% of individuals experiencing dysmenorrhea seek initial consultation from their primary care provider. The condition contributes to a decline in quality of life, increasing rates of absenteeism, and an elevated susceptibility to depression and anxiety.(40) Dysmenorrhea, characterized by abdominal cramping during menstruation, retards daily activities due to its painful nature. This illness, which usually causes pelvic discomfort and menstrual abnormalities, is characterized by symptoms such as headache, nausea, diarrhea, vomiting, and lumbago. Dysmenorrhea surpasses other gynecological issues in terms of its prevalence and adverse effects. Regardless of factors like age, nationality, or economic status, dysmenorrhea stands as the primary cause of gynecological morbidity among women of reproductive age.(41) Its repercussions extend beyond individual sufferers to society, leading to considerable productivity loss annually. Consequently, the World Health Organization has recognized dysmenorrhea as a major contributor to CPP. Heat therapy, such as heating pads, helps relax muscles and ease cramps.(42) Lifestyle modifications like regular exercise and a healthy diet can lessen symptoms. Hormonal contraceptives, like birth control pills, regulate hormonal fluctuations, reducing pain intensity. Alternative therapies like acupuncture and yoga may offer relief. Understanding individual triggers and stress management techniques are integral parts of holistic management.

Fibroid Pain

As women age, the occurrence probability of uterine fibroid tumors, also known as leiomyomas, tends to increase.(43) Research suggests that the prevalence of these tumors identified through the US rises from 4 percent among women aged 20 to 30 to 11 to 18 percent among those aged 30 to 40, and further to 33 percent among women aged 40 to 60.(44) Often, women seek guidance from family physicians when experiencing symptoms related to fibroid tumors or upon incidental detection during medical examinations. Uterine fibroids, benign growths originating in the uterine muscle, can provoke various symptoms that significantly affect a woman’s well-being.(45) Among these symptoms, pelvic pain is prominent, ranging from mild discomfort to intense cramping, depending on fibroid size and placement. Furthermore, fibroids may contribute to heavy menstrual bleeding, resulting in prolonged periods, clot formation, and anemia due to excessive blood loss. Management strategies encompass medical, surgical, and non-invasive approaches. Analgesics like NSAIDs alleviate acute pain, while hormonal therapies regulate menstrual cycles, reducing symptoms. Minimally invasive procedures such as uterine artery embolization or MRI-guided focused ultrasound offer alternatives to surgery, preserving fertility.(46) Surgical options like myomectomy or hysterectomy are considered for severe cases.(47) Holistic approaches like yoga, acupuncture, and dietary changes complement conventional treatments, offering holistic relief. Multidisciplinary care tailor’s interventions to individual needs, enhancing fibroid pain management efficacy.

Ovarian Cysts

Ovarian hormones, including luteinizing hormone (LH), follicle-stimulating hormone (FSH), estrogens, and progesterone, undergo regular fluctuations over 28 days.(48) These fluctuations are instrumental in the maturation of oocytes and the subsequent release of a single egg, marking the ovarian cycle. Simultaneously, the menstrual cycle involves changes in the uterine lining, which is shed if fertilization does not occur. The hypothalamus releases gonadotropin-releasing hormone (GnRH), prompting the pituitary gland to secrete LH and FSH, stimulating the ovary to produce estrogen and progesterone.(49) Typically spanning 28 days (but ranging from 25 to 32 days), menstrual cycles begin with the shedding of the uterine lining. Around mid-cycle, an LH surge triggers the release of progesterone, leading to ovulation and the commencement of the luteal phase. After ovulation, the corpus luteum releases significant quantities of progesterone, peaking during the mid-luteal phase alongside a moderate increase in estrogen compared to the follicular phase.(50) This hormonal transition suppresses the secretion of estrogen and progesterone, resulting in the shedding of the uterine lining, menstruation, and the start of a new menstrual cycle. Pain management strategies include over-the-counter pain relievers like ibuprofen or acetaminophen for mild pain. For more severe pain, prescription medications or hormone therapy may be necessary to shrink the cyst.(51) In some cases, surgery is required to remove large cysts causing significant pain. Non-medical approaches such as heat therapy, gentle exercise, and relaxation techniques can relieve relief. Regular monitoring and consultation with a healthcare provider are essential for effective pain management and overall well-being.

Vulvodynia

Vulvodynia presents with vulvar pain, whether spontaneous or triggered by touch, occurring in various sexual and non-sexual contexts, including penetration (intercourse).(52) Musculoskeletal and neurological issues, as well as concurrent pain disorders such as fibromyalgia and, irritable bowel syndrome, and psychosocial factors, all contribute to vulvodynia.(53) The Diagnostic and Statistical Manual of Mental Disorders classifies vulvodynia as ‘genito-pelvic pain/penetration disorder,’ replacing earlier classifications.(54) While overlapping with vulvodynia, this new classification encompasses broader aspects, including deep or pelvic pain during intercourse. Apart from pain, vulvodynia significantly impacts sexual desire, arousal, frequency, and satisfaction, influencing psychological and relationship well-being for affected individuals and their partners. Vulvodynia can lead to distressing sexual experiences, contributing to anxiety, depression, and decreased quality of life.(55) Treatment approaches often involve a multidisciplinary approach, including physical therapy, medications, psychological interventions, and lifestyle modifications. However, finding effective management strategies can be challenging due to the complex nature of the condition and individual variability in response to treatment. Patient education and support are essential in managing vulvodynia, helping individuals to ease their symptoms and seek appropriate care. Research into the underlying mechanisms and innovative therapies continues to advance, offering hope for improved outcomes and enhanced quality of life for those with vulvodynia. (Figure 2)

Figure 2. Pain management in Vulvodynia.

Interstitial Cystitis

Interstitial cystitis/painful bladder syndrome (IC/PBS) manifests as a persistent condition characterized by pelvic pain and disturbances in urinary storage, including a relentless urge to urinate, frequent nighttime urination, and increased urinary frequency.(56) Although widespread, its precise etiology remains elusive, resulting in diverse treatment modalities. Early detection of IC/PBS presents difficulties due to symptom similarities with other urogynaecological disorders, potentially leading to considerable deterioration in patients’ quality of life.(57) Healthcare providers must understand its development, clinical presentations, and diagnostic criteria to promptly implement appropriate and efficient therapeutic measures for their patients, ensuring optimal outcomes and improved well-being. Furthermore, research into novel diagnostic tools and targeted therapies is crucial to effectively refine treatment approaches and alleviate symptoms. By fostering interdisciplinary collaborations and advancing scientific understanding, clinicians can provide holistic care and support to individuals affected by IC/PBS, enhancing their overall health and quality of life.(58)

Pelvic Organ Prolapse

Pelvic organ prolapse arises when the anterior or posterior vaginal walls, uterus, or vaginal apex protrude into the vagina, causing a descent through one or more of these structures.(59) Urogenital prolapse entails the downward displacement of pelvic organs, leading to the protrusion of the vagina, uterus, or both. Symptoms include pelvic pressure or protrusion through the vaginal opening, alongside issues like urine leakage, difficulties with urination, fecal incontinence, incomplete bowel movements, and sexual dysfunction.(60) Pelvic organ prolapses, a disorder unique to women, appears in a variety of ways that impact distinct areas of the vaginal anatomy, including the anterior and posterior vaginal walls, uterus, and vaginal apex. It’s vital to remember that pelvic organ prolapse is distinct from rectal prolapse, which affects both genders. It is the most common cause of hysterectomy among postmenopausal women, accounting for a considerable proportion of surgeries across all age categories. While it seldom causes serious health problems, it does create discomfort in the lower genital, urinary, and gastrointestinal systems, which affects a woman’s everyday life and well-being. The anterior vaginal wall is frequently the area most impacted by prolapse, which usually involves the bladder’s fall, known as cystocele. Apical prolapse, on the other hand, involves the uterus or vaginal cuff following a hysterectomy and might include the small intestine (enterocele), bladder, or colon.(61) Similarly, posterior vaginal wall collapse affects the rectum (rectocele) and, in certain cases, the small or large intestine. The Pelvic Organ Prolapse Quantitation System can be used to assess uterovaginal support.(62) Pain management strategies for POP-related abdominal discomfort include pelvic floor physical therapy to strengthen muscles, supportive devices like pessaries, lifestyle changes such as weight management and avoiding heavy lifting, and surgical intervention to repair the prolapse in severe cases.(63) Regular monitoring and consultation with a healthcare provider are essential for personalized treatment plans.

Figure 3. Symptoms of Pelvic Organ Prolapse.

Birth Control Management

Pregnancy among people with pulmonary arterial hypertension (PAH) is associated with serious consequences, with fatality rates exceeding 50%. Medical therapy for PAH has advanced significantly in recent years, leading to improved hemodynamics, exercise capacity, quality of life, and overall results.(64) Pregnant women with PAH require well-planned, multidisciplinary management, ideally in a dedicated pulmonary hypertension referral center, with an emphasis on close monitoring before, during, and after childbirth. PAH, which is defined as increasing pulmonary vascular blockage leading to high pulmonary vascular resistance (PVR) and possible right heart failure, affects people of all sexes and ages, particularly young women.(65) As a result, controlling contraception and pregnancy becomes an important priority in this patient demography. Furthermore, Gynaecologic discomfort, a common symptom in many young women with PAH, complicates controlling their illness during pregnancy. Pain management strategies must prioritize both maternal well-being and fetal safety. Non-pharmacological interventions like relaxation techniques, massage, and physical therapy can provide relief while minimizing medication use. When medications are necessary, careful consideration of their safety profile is crucial, as certain pain relievers can adversely affect PAH and fetal development.(66) Close monitoring by a multidisciplinary team comprising obstetricians, cardiologists, and pain specialists is essential to ensure optimal pain control while minimizing risks to both mother and fetus.

Gynaecological examination

Regular gynecological check-ups, alternatively known as pelvic or well-woman examinations, form an integral part of women’s healthcare, focusing on sustaining reproductive well-being and identifying potential concerns at an early stage. Annual examination for sexually active women or those aged 21 and above is advised, and it encompasses a thorough assessment of the reproductive system. Throughout a routine gynecological assessment, a medical practitioner initiates by reviewing the patient’s medical background and addressing any queries the individual may raise. The physical examination commonly involves an external inspection of the genital region, followed by the insertion of a speculum to examine the vagina and cervix.(67) Pap smears, utilized to screen for cervical cancer and human papillomavirus (HPV), are routinely conducted during these check-ups.(68,69) Healthcare providers may manually examine the uterus and ovaries to detect irregularities or indications of conditions like fibroids or ovarian cysts. Depending on factors such as the patient’s age, medical history, and risk factors, further assessments or screenings such as breast examinations, STD screenings, or mammograms may be suggested. Routine gynecological evaluations presents an avenue for healthcare providers to enlighten patients on reproductive health, contraception, sexually transmitted infections, and preventive measures. Through open dialogue and consistent screenings, these examinations significantly promote overall well-being and early identification of Gynaecological concerns.

Gynecological Surgery

To minimize the risk of ureter injury during gynecologic surgeries, it’s imperative to map the pelvic anatomy and identify vulnerable areas accurately. Employing methods like preoperative imaging and real-time visualization aids in this crucial task. Furthermore, inserting ureteral stents for six weeks after surgery, followed by an intravenous pyelogram (IVP) for patency assessment, is a common preventative strategy.(70) Gynaecological surgeries, including hysterectomy and laparoscopic procedures, are performed to treat conditions like endometriosis, fibroids, and pelvic organ prolapse.(71) These procedures are typically conducted by gynecologists or oncologists trained in minimally invasive or robotic-assisted techniques. Patients should have detailed discussions with their healthcare providers regarding potential risks, benefits, and alternative treatments. Despite preventive measures, complications such as Gynaecologic pain may still arise post-surgery, necessitating careful monitoring and appropriate intervention.

Fertility Treatments  

Numerous studies have established a robust link between increasing BMI and increased reliance on ovulation-inducing medications. Severe obesity often necessitates higher doses of clomiphene, sometimes reaching up to 200 mg daily, to initiate ovulation.(72) Correspondingly, the dosage of gonadotrophins required for ovulation induction also tends to increase with BMI. Fedorcsak et al.’s research, based on 2660 IVF/ICSI cycles, corroborated this pattern, highlighting a direct correlation between BMI and the total amount of follicle-stimulating hormone (FSH) needed.(74) Elevated BMIs consistently corresponded with greater FSH demand for ovarian stimulation, indicating resistance to ovulation-stimulating agents among obese individuals. However, the predictive value of obesity in infertility treatment outcomes remains debatable. While certain studies have reported lower pregnancy and implantation rates in obese women, others have found no significant impact of higher body weights. The reduced reproductive performance observed in obese women during both natural and assisted conception cycles may be attributed to various factors, including diminished implantation and pregnancy rates, heightened rates of preclinical and clinical miscarriage, and increased pregnancy complications for both mother and fetus. These challenges have been linked to various endocrine and metabolic changes affecting steroid metabolism, insulin production and function, and hormone regulation, such as leptin, resistin, ghrelin, and adiponectin.(74) Such abnormalities could influence crucial reproductive processes like follicle growth, corpus luteum function, early embryo development, trophoblast activity, and endometrial receptivity. Gynecological discomfort may exacerbate the challenges faced by obese women undergoing reproductive treatments. Abdominal pain during fertility treatment can stem from various causes. Ovarian hyperstimulation syndrome (OHSS), a potential complication of ovarian stimulation medications, may lead to bloating and discomfort.(75) Additionally, procedures like egg retrieval or embryo transfer can cause temporary discomfort due to manipulation of the ovaries or uterus. In some cases, underlying conditions like endometriosis or pelvic inflammatory disease could contribute to abdominal pain. It’s crucial to communicate any persistent or severe pain to your healthcare provider, as it could signify complications needing attention. Monitoring symptoms closely ensures timely intervention, optimizing the chances of a successful fertility treatment outcome.

Conclusion

In conclusion, gynaecologic pain, particularly CPP, represents a significant challenge in women’s healthcare. Despite advances in obstetrics, its management still needs to be addressed. Neuropelveology, an interdisciplinary approach focusing on pelvic nerve pathologies, offers valuable insights beyond traditional gynecology. Neuropathic pelvic pain, characterized by sensory nerve dysfunction, poses diagnostic complexities, emphasizing the importance of thorough clinical examinations and over-reliance on imaging techniques. Multidisciplinary management strategies, including centrally acting neuromodulatory medications, are often necessary for effective treatment. This review stresses various Gynaecologic conditions contributing to pelvic pain, highlighting the critical role of Gynaecological examinations in promptly identifying and managing these conditions to improve women’s reproductive health and quality of life. It also discusses essential aspects of women’s healthcare, including fertility treatments, STI screening, menstrual disorders, and Gynaecological surgeries, emphasizing the need for comprehensive care to address the diverse needs of women across different life stages. Prioritizing Gynaecologic pain management and women’s reproductive health is essential for enhancing healthcare outcomes and promoting overall well-being.

Conflict of interest

Conflict of interest declared none.

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