Chronic pelvic pain and pelvic venous disorders: the gynecologist's point of view

Chronic pelvic pain (CPP) is a very common symptom with multiple potential etiologies. Very often, it is the result of an overlap of several pain-generating disorders of the reproductive tract, gastrointestinal system, urological organs, musculoskeletal system, and psychoneurological system. Living with CPP carries a heavy economic and social burden. Due to the complex etiology of CPP, to achieve good treatment results, the approach should be multimodal and requires a cooperative interdisciplinary team of clinicians, including gynecologists, vascular surgeons or phlebologists, interventional radiologists, gastroenterologists, urologists, physiotherapists, and psychologists. All the potential etiologies should be checked and ruled out before establishing the treatment modality. Central pain sensitization should also be considered. Appropriate management from the first presentation can improve health-related quality of life, work productivity, and health care utilization and reduce an endless series of referrals, investigations, and inappropriate treatment. This article presents the potential etiologies of CPP with a primary focus on gynecological issues, including pelvic venous disorders (PeVDs), which are an entity on the borderline of gynecology and vascular surgery and are an increasingly recognizable pathology.