[Chronic pelvic pain syndrome--a multifactorial syndrome]

As a clinically significant syndrome in the field of gynaecology, chronic pelvic pain syndrome (CPPS) leads to illnesses which are prolonged over many years and, in some cases, to a high incidence of surgical intervention. Answers to questions about its aetiology, gynaecological associations, such as adhesions or endometriosis, and new approaches to diagnosis and treatment are urgently required.

Psychometric data were evaluated in 106 patients with CPPS and in 36 clinical controls with vulvodynia. Psychological testing was undertaken in 68 patients with CPPS and 24 with vulvodynia, in comparison with a control group of healthy women (n = 34). DSM IV and ICD 10 classifications were used and neurosis-orientated diagnoses were also assigned. In order to investigate musculoskeletal diseases in CPPS, these patients (106/36) underwent orthopaedic examination and were compared with a control group with no pain (n = 35).

An interdisciplinary diagnostic work-up proved to be of clinical relevance, with a significantly higher frequency of cases of facet syndrome in CPPS. After an interdisciplinary diagnostic work-up and treatment directed towards psychosomatic symptoms, the gynaecological differential diagnosis may possibly include laparoscopy. The psychological aggression conflict associated with a significantly greater number of patients with so-called "early disturbance" and latent depression can find pronounced expression during treatment. Results of qualitative investigations in patients with endometriosis show typical psychological symptoms.

Treatment that is both interdisciplinary and strictly orientated towards psychosomatic disorders seems appropriate to this complex syndrome. In particular, the psychological dynamics of an aggression conflict in the patient must be taken into consideration, so that this conflict does not transmit to the treatment.