The Interplay Between Chronic Pelvic Pain and Pelvic Organ Prolapse

Chronic pelvic pain (CPP) affects approximately 26% of the world's female population and has various proposed etiologies. This manuscript aims to review concepts related to pelvic organ prolapse (POP) and CPP, encompassing its etiology, risk factors, clinical findings, and pain management.

A narrative review was performed using MeSH terms and text words on PubMed, and the Cochrane Database of Systematic Reviews through May 2024. A total of 33 references were used to address the questions posed in this review.

Specific risk factors for CPP associated with POP include pain antedating POP onset, POP surgery duration, and extent of soft tissue trauma. Studies indicate that uterosacral ligament repair performed during surgical interventions for POP correction has alleviated CPP symptoms whether performed vaginally or laparoscopically. Women with preexisting CPP or central sensitization syndrome (CSS) undergoing pelvic reconstructive surgery for POP may experience less favorable postoperative outcomes compared to those without preexisting pain conditions. These outcomes include lower patient satisfaction, less resolution of discomfort, and poorer improvement in urinary symptoms.

On the basis of current evidence, surgeries for POP correction, especially those involving the uterosacral ligament, have shown a positive impact on reducing pelvic pain. However, untreated CPP is associated with lower satisfaction and less improvement in outcomes after POP surgery regarding pelvic symptoms and quality of life. Screening for and treating CPP conditions prior to POP surgery should be prioritized. Pain management of CPP should be addressed preoperatively, perioperatively, and postoperatively.