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Minerva Obstetrics and Gynecology 2021 Apr 27

DOI: 10.23736/S2724-606X.21.04779-1

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

A deep insight into pelvic pain and endometriosis: a review of the literature from pathophysiology to clinical expressions

Luisa MASCIULLO, Maria F. VISCARDI, Ilaria PIACENTI, Sara SCARAMUZZINO, Alessandra CAVALLI, Maria G. PICCIONI, Maria G. PORPORA

Department of Maternal and Child Health and Urological Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy


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Endometriosis is a chronic inflammatory disease that affects approximately 10% of women of reproductive age. Its clinical manifestations are highly heterogeneous, but pelvic pain is the most frequent, causing functional disability. Cyclic or acyclic chronic pelvic pain (CPP), dysmenorrhea and dyspareunia are frequent symptoms which often compromise all aspects of the women’s quality of life (QoL). The pathophysiology of endometriosis-related pain is extremely complex and not always clear. The aim of this literature review is to focus on recent updates on the clinical presentation, the pathophysiology and the most important mechanisms involved in the pathogenesis of pelvic pain in endometriosis. A literature search in the Cochrane library, PubMed, Scopus and web of Science databases has been performed, identifying articles from January 1995 to November 2020. Several processes seem to be involved in the pathogenesis of pain, but many aspects are still unclear. Scientific evidence has shown that a correlation between pain severity and stage of endometriosis rarely occurs, whereas there is a significant correlation between pain and the presence of deep endometriosis. Onset and intensity of pain may be due to a complex process involving central sensitization and peripheral activation of nociceptive pathways as well as dysfunction of the immune system and of the hypothalamic-pituitary-adrenal (HPA) axis. A deeper understanding of these different pathogenetic mechanisms may improve future treatments in women with painful endometriosis.


KEY WORDS: Endometriosis; Chronic pelvic pain (CPP); Dysmenorrhea; Dyspareunia; Dysuria; Dyschezia; Hyperalgesia; Central sensitization; Immune system

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