Psychogenic chronic pelvic pain: diagnosis and management

By the time that the pelvalgia patient seeks treatment, her chronic tension, anxiety, stress, and related somatic symptoms, which usually have moderated her fear of repeat assault or punishment by the aggressor-parent, has begun to disintegrate. The patient usually has little or no insight into the fact that her feelings of being trapped, helpless, and victimized in her marriage, job, or other interpersonal relationships can be symbols of the original sexual trauma. The depressed patient may be unaware that suicidal thoughts and actions, if present, are a reflection of her sense of helplessness, hopelessness, and victimization. Hence, CPP may be a symptom of a wide spectrum of disorders, both organic and psychological. While the patient is undergoing evaluation of pelvic pain, it is essential that clinicians remain aware that the patient's psychogenic symptoms are an attempt to reinforce a faltering ego. Additionally, it is important that they recognize that previous attempts at diagnosis and therapy of CPP and other somatic complaints usually have reinforced the belief that the symptoms are physically based and unrelated to any psychological factors. A number of prospective studies currently are underway to characterize further the relationships between complaints of chronic pelvic pain, personality functioning, and history of sexual trauma. Without data on very long-term follow-up, our understanding of the precise psychodevelopmental pathophysiology and long-term prognosis of CPP currently remains incomplete.