[Chronic pelvic pain. Expression of a psychological problem]

Chronic pelvic pain (CPP) is one of the most difficult and perplexing problems encountered in gynecology. Lately CPP has been attributed, among many other etiologies to tension myalgia of the pelvic floor. Identification of trigger points, myofascial problems and the Carnett test have been considered helpful. We hypothesized that these are not the cause of CPP but a sign of psychic disturbance.

Seventy patients, 40 with CPP, 20 with organic pain and 10 normal controls were investigated. A pain index was defined and used. A blinded psychologic evaluation was conducted in all cases using the Rorschach and a semi structured psychologic interview. A psychometric index was calculated.

The algometric test was low in controls. It was in the higher range in CPP patients and in both cases correlated well with the psychometric index. CPP patients expressed a variety of psychic disturbances. The response of patients with organic CPP to etiologic treatment could be predicted by the algometric index, low index = good response; high index = difficult follow up.

Trigger points, tension myalgia and abdominal cellulalgia are not the cause of CPP. They are the sign of somatization of neurotic or psychosomatic problems in the pelvis. They represent a useful diagnostic tool, which will allow an individualized, multidisciplinary approach to diagnosis and management of CPP.