Chronic pelvic pain syndrome. A multifactorial clinical picture with indication for interdisciplinary treatment

Chronic pelvic pain syndrome (CPPS) accounts for ca. 15-20% of all consulta tions in out-patient gynecological care; almost 40% of all laparascopies re sult from it. Its prevalence in women in reproductive age is 15-30%. The definition of CPPS refers to th e organic basis and psychological chara cteristics of the pain, which, independently of organic findings, exists fo r 6 months. There are gynecological and nongynecological causes that form t he basis for possible organ disease: endometriosis, adhesions, cysts, pelvi c inflammatory disease, pelvic congestion syndrome, gastrointestinal diseas e, lactose intolerance, and urological, surgical, and musculoskeletal disea se. An interdisciplinary diagnosis of the organic gynecological and nongynecolo gical causes and of the patient's psychosocial state of being must be the b asis for any indication of laparoscopy. The psychic factors in CPPS must al ways be taken into account and weighted independently of any organic findin gs. An interdisciplinary differential diagnosis, psychodiagnosis, including trauma anamnesis, and neurosis-oriented diagnoses provide the indicators a nd prognosis for treatment. The findings of depression in CPPS must be exte nded to include the recognition and clarification of any central aggressive conflict with effects on treatment.