ABUSE-RELATED POSTTRAUMATIC-STRESS-DISORDER AND ALTERATIONS OF THE HYPOTHALAMIC-PITUITARY-ADRENAL AXIS IN WOMEN WITH CHRONIC PELVIC PAIN

Objective: Although numerous organic conditions may cause chronic pelv ic pain (CPP), diagnostic laparoscopy reveals a normal pelvis in many patients with CPP. However, psychological studies yield a high frequen cy of psychopathology and increased prevalences of chronic stress and traumatic life events, ie, sexual and physical abuse, in women with CP P, suggesting a relationship between posttraumatic stress disorder (PT SD) and CPP. As chronic stress and PTSD have been associated with spec ific alterations of the hypothalamic-pituitary-adrenal (HPA) axis, we explored stress history, psychopathology and HPA axis alterations in w omen with CPP. Method: We recruited 16 patients with CPP and 14 painfr ee, infertile controls from a general hospital where diagnostic laparo scopy was performed. Psychological assessment included standardized in terviews on clinical symptoms, abuse experiences and major Life events as well as psychometric testing for PTSD-like symptoms and depression . Endocrinological evaluation involved determinations of diurnal saliv ary cortisol levels and hormonal responses to a corticotropin-releasin g factor (CRF) stimulation test (100 mu g human CRF) and a low-dose de xamethasone suppression test (0.5 mg). Results: We observed increased prevalences of abuse experiences and PTSD in women with CPP as well as a higher total number of major life events, whereas the mean extent o f depression was within the normal range. With respect to endocrine me asures, women with CPP demonstrated normal to low diurnal salivary cor tisol levels, normal plasma-adrenocorticotropin (ACTH), but reduced sa livary cortisol levels in the CRF stimulation test, and an enhanced su ppression of salivary cortisol by dexamethasone. Conclusion: Women wit h CPP demonstrate HPA axis alterations, that partly parallel and partl y contrast neuroendocrine correlates of PTSD, but show marked similari ty to findings in patients with other stress-related bodily disorders. These findings suggest that a lack of protective properties of cortis ol may be of relevance for the development of bodily disorders in chro nically stressed or traumatized individuals.