Gynäkologischer Schmerz

Dharmesh Kapoor | 8. August 2012

Autoren und Interessenskonflikte


Die Gebärmutter, Zervix und Eierstöcke teilen die gleiche viszerale Innervation wie das untere Ileum, Sigmoid, Kolon und Rektum. Signale laufen über die sympathischen Nerven zu den Rückenmarkssegmenten T10 bis L1. Wegen dieses geteilten Verlaufes ist es oft schwierig, zwischen Schmerz gynäkologischen und gastrointestinalen Ursprungs zu unterscheiden.

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  1. Jones HW, Jones GS. Pelvic pain and dysmenorrhea. In: Berek JS, Adashi EY, Hillard PA, eds. Novak's Textbook of Gynecology. 1996. 12th ed. Baltimore, Md: Williams & Wilkins; 399-428.
  2. [Best Evidence] Hajenius PJ, Mol F, Mol BW, Bossuyt PM, Ankum WM, van der Veen F. Interventions for tubal ectopic pregnancy. Cochrane Database Syst Rev. Jan 24 2007;CD000324.
  3. CDC. Sexually transmitted diseases treatment guidelines 2002. Centers for Disease Control and Prevention. MMWR Recomm Rep. May 10 2002;51(RR-6):1-78.
  4. Update to CDC STD treatment guidelines 2006: fluoroquinolones no longer recommended for GC infections. 56[14]. MMWR: CDC; 2007 Apr 13. 332-6.
  5. Donnez J, Tatarchuk TF, Bouchard P, et al. Ulipristal acetate versus placebo for fibroid treatment before surgery. N Engl J Med. Feb 2 2012;366(5):409-20.
  6. Kresch AJ, Seifer DB, Sachs LB, Barrese I. Laparoscopy in 100 women with chronic pelvic pain. Obstet Gynecol. Nov 1984;64(5):672-4.
  7. Cunanan RG, Courey NG, Lippes J. Laparoscopic findings in patients with pelvic pain. Am J Obstet Gynecol. Jul 1 1983;146(5):589-91.
  8. Hughes E, Brown J, Collins JJ, Farquhar C, Fedorkow DM, Vandekerckhove P. Ovulation suppression for endometriosis. Cochrane Database Syst Rev. Jul 18 2007;CD000155.
  9. Vercellini P, Crosignani PG, Abbiati A, Somigliana E, Viganò P, Fedele L. The effect of surgery for symptomatic endometriosis: the other side of the story. Hum Reprod Update. Mar-Apr 2009;15(2):177-88.
  10. Al Kadri H, Hassan S, Al-Fozan HM, Hajeer A. Hormone therapy for endometriosis and surgical menopause. Cochrane Database Syst Rev. Jan 21 2009;CD005997.
  11. Alborzi S, Momtahan M, Parsanezhad ME, et al. A prospective, randomized study comparing laparoscopic ovarian cystectomy versus fenestration and coagulation in patients with endometriomas. Fertil Steril. Dec 2004;82(6):1633-7.
  12. Hart RJ, Hickey M, Maouris P, Buckett W. Excisional surgery versus ablative surgery for ovarian endometriomata. Cochrane Database Syst Rev. Apr 16 2008;CD004992.
  13. Waller KG, Shaw RW. Gonadotropin-releasing hormone analogues for the treatment of endometriosis: long-term follow-up. Fertil Steril. Mar 1993;59(3):511-5.
  14. Weissman AM, Hartz AJ, Hansen MD, Johnson SR. The natural history of primary dysmenorrhoea: a longitudinal study. BJOG. Apr 2004;111(4):345-52.
  15. Proctor ML, Smith CA, Farquhar CM, Stones RW. Transcutaneous electrical nerve stimulation and acupuncture for primary dysmenorrhoea. Cochrane Database Syst Rev. 2002;CD002123.
  16. Johnson NP, Farquhar CM, Crossley S, et al. A double-blind randomised controlled trial of laparoscopic uterine nerve ablation for women with chronic pelvic pain. BJOG. Sep 2004;111(9):950-9.
  17. Zullo F, Palomba S, Zupi E, et al. Long-term effectiveness of presacral neurectomy for the treatment of severe dysmenorrhea due to endometriosis. J Am Assoc Gynecol Laparosc. Feb 2004;11(1):23-8.
  18. [Best Evidence] Proctor ML, Latthe PM, Farquhar CM, Khan KS, Johnson NP. Surgical interruption of pelvic nerve pathways for primary and secondary dysmenorrhoea. Cochrane Database Syst Rev. Oct 19 2005;CD001896.
  19. Panganamamula UR, Harmanli OH, Isik-Akbay EF, et al. Is prior uterine surgery a risk factor for adenomyosis?. Obstet Gynecol. Nov 2004;104(5 Pt 1):1034-8.
  20. Howard FM. The role of laparoscopy in chronic pelvic pain: promise and pitfalls. Obstet Gynecol Surv. Jun 1993;48(6):357-87.
  21. ACOG. ACOG technical bulletin. Chronic pelvic pain. Number 223--May 1996 (replaces no. 129, June 1989). American College of Obstetricians and Gynecologists. Int J Gynaecol Obstet. Jul 1996;54(1):59-68.
  22. Demco L. Pain mapping of adhesions. J Am Assoc Gynecol Laparosc. May 2004;11(2):181-3.
  23. Chan CL, Wood C. Pelvic adhesiolysis--the assessment of symptom relief by 100 patients. Aust N Z J Obstet Gynaecol. Nov 1985;25(4):295-8.
  24. Peters AA, Trimbos-Kemper GC, Admiraal C, et al. A randomized clinical trial on the benefit of adhesiolysis in patients with intraperitoneal adhesions and chronic pelvic pain. Br J Obstet Gynaecol. Jan 1992;99(1):59-62.
  25. Bost BW. Deflecting sigmoid adhesions: an anatomic cause of chronic pelvic pain and irritable bowel syndrome. Obstet Gynecol. Apr 2001;97(4 Suppl 1):S27.
  26. Keltz MD, Gera PS, Olive DL. Prospective randomized trial of right-sided paracolic adhesiolysis for chronic pelvic pain. JSLS. Oct-Dec 2006;10(4):443-6.
  27. Ahmad G, Duffy JM, Farquhar C, Vail A, Vandekerckhove P, Watson A, et al. Barrier agents for adhesion prevention after gynaecological surgery. Cochrane Database Syst Rev. Apr 16 2008;CD000475.
  28. Roberts LM, Sanfilippo JS, Raab S. Effects of laparoscopic lavage on adhesion formation and peritoneum in an animal model of pelvic inflammatory disease. J Am Assoc Gynecol Laparosc. Nov 2002;9(4):503-7.
  29. Thompson WG, Longstreth GF, Drossman DA, et al. Functional bowel disorders and functional abdominal pain. Gut. Sep 1999;45 Suppl 2:II43-7.
  30. Drossman DA. Chronic functional abdominal pain. Am J Gastroenterol. Nov 1996;91(11):2270-81.
  31. Peters KM, Carrico DJ, Kalinowski SE, Ibrahim IA, Diokno AC. Prevalence of pelvic floor dysfunction in patients with interstitial cystitis. Urology. Jul 2007;70(1):16-8.
  32. Slocumb JC. Chronic somatic, myofascial, and neurogenic abdominal pelvic pain. Clin Obstet Gynecol. Mar 1990;33(1):145-53.
  33. Langford CF, Udvari Nagy S, Ghoniem GM. Levator ani trigger point injections: An underutilized treatment for chronic pelvic pain. Neurourol Urodyn. 2007;26(1):59-62.
  34. Abbott JA, Jarvis SK, Lyons SD, Thomson A, Vancaille TG. Botulinum toxin type A for chronic pain and pelvic floor spasm in women: a randomized controlled trial. Obstet Gynecol. Oct 2006;108(4):915-23.
  35. Weiss JM. Pelvic floor myofascial trigger points: manual therapy for interstitial cystitis and the urgency-frequency syndrome. J Urol. Dec 2001;166(6):2226-31.
  36. Clemons JL, Arya LA, Myers DL. Diagnosing interstitial cystitis in women with chronic pelvic pain. Obstet Gynecol. Aug 2002;100(2):337-41.
  37. FitzGerald MP, Brensinger C, Brubaker L, Propert K,. What is the pain of interstitial cystitis like?. Int Urogynecol J Pelvic Floor Dysfunct. Jan 2006;17(1):69-72.
  38. Hanno PM, Sant GR. Clinical highlights of the National Institute of Diabetes and Digestive and Kidney Diseases/Interstitial Cystitis Association scientific conference on interstitial cystitis. Urology. Jun 2001;57(6 Suppl 1):2-6.
  39. van Ophoven A, Pokupic S, Heinecke A, Hertle L. A prospective, randomized, placebo controlled, double-blind study of amitriptyline for the treatment of interstitial cystitis. J Urol. Aug 2004;172(2):533-6.
  40. Soucy F, Gregoire M. Efficacy of prednisone for severe refractory ulcerative interstitial cystitis. J Urol. Mar 2005;173(3):841-3; discussion 843.
  41. Sant GR, Propert KJ, Hanno PM, et al. A pilot clinical trial of oral pentosan polysulfate and oral hydroxyzine in patients with interstitial cystitis. J Urol. Sep 2003;170(3):810-5.
  42. Parsons CL. Successful downregulation of bladder sensory nerves with combination of heparin and alkalinized lidocaine in patients with interstitial cystitis. Urology. Jan 2005;65(1):45-8.
  43. Melchior D, Packer CS, Johnson TC, Kaefer M. Dimethyl sulfoxide: does it change the functional properties of the bladder wall?. J Urol. Jul 2003;170(1):253-8.
  44. Mayer R, Propert KJ, Peters KM, et al. A randomized controlled trial of intravesical bacillus calmette-guerin for treatment refractory interstitial cystitis. J Urol. Apr 2005;173(4):1186-91.
  45. Dawson TE, Jamison J. Intravesical treatments for painful bladder syndrome/ interstitial cystitis. Cochrane Database Syst Rev. Oct 17 2007;CD006113.
  46. Gittes RF. Female prostatitis. Urol Clin North Am. Aug 2002;29(3):613-6.
  47. Butrick CW. Atypical pelvic pain in gynecology. Presented at: The First National Pelvic Pain Symposium. May 12, 1995;Columbus: Ohio State University.
  48. Kim SW, Paick JS, Ku JH. Percutaneous posterior tibial nerve stimulation in patients with chronic pelvic pain: a preliminary study. Urol Int. 2007;78(1):58-62.
  49. Suckling J, Lethaby A, Kennedy R. Local oestrogen for vaginal atrophy in postmenopausal women. Cochrane Database Syst Rev. 2003;CD001500.
  50. Bornstein J, Zarfati D, Goldshmid N, et al. Vestibulodynia--a subset of vulvar vestibulitis or a novel syndrome?. Am J Obstet Gynecol. Dec 1997;177(6):1439-43.

Autoren und Interessenskonflikte


Dharmesh Kapoor, MBBS, MD, MRCOG Consultant Gynecologist, Royal Bournemouth Hospital

Es liegen keine Interessenkonflikte vor.


Gamal Mostafa Ghoniem, MD, FACS Professor of Urology, Chief, Division of Female Urology, Pelvic Reconstructive Surgery, and Voiding Dysfunction, Department of Urology, University of California, Irvine, School of Medicine

Offenlegung: Astellas honorierte Lehr- und Vortragstätigkeit; koloplastische Eingriffe, honorierte Beratertätigkeit, Gremienmitgliedschaft; uroplastische Eingriffe, honorierte Beratertätigkeit

G Willy Davila, MD Chairman, Department of Gynecology, Section of Urogynecology and Reconstructive Pelvic Surgery, Cleveland Clinic Florida

Offenlegung: American Medical Systems honorierte Beratertätigkeit; Astellas honorierte Beratertätigkeit; Watson Pharma honorierte Beratertätigkeit; CL Medical honorierte Beratertätigkeit; Warner Chilcott honorierte Lehr- und Vortragstätigkeit


Jordan G Pritzker, MD, MBA, FACOG Assistant Professor of Obstetrics/Gynecology and Women's Health, Women's Comprehensive Health Center, Hofstra University School of Medicine; Attending Physician, Department of Obstetrics and Gynecology, Long Island Jewish Medical Center

Es liegen keine Interessenkonflikte vor.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Offenlegung: Mitarbeiter von Medscape

Frederick B Gaupp, MD Consulting Staff, Department of Family Practice, Hancock Medical Center

Es liegen keine Interessenkonflikte vor.


Michel E Rivlin, MD Professor, Department of Obstetrics and Gynecology, University of Mississippi School of Medicine

Es liegen keine Interessenkonflikte vor.


Diese Review wurde ursprünglich am 9. Februar 2012 auf präsentiert. Übersetzer: Isabelle Schmitter, gynäkologische Assistentin.

Wir bitten darum, Diskussionen höflich und sachlich zu halten. Beiträge werden vor der Veröffentlichung nicht überprüft, jedoch werden Kommentare, die unsere Community-Regeln verletzen, gelöscht.