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Modern obstetric advances have improved labor management with pain medication integration, yet gynecologic pain management remains less prioritized. Chronic pelvic pain (CPP) impacts 7 to 24% of the population, significantly reducing quality of life and burdening healthcare systems. Patients commonly report perineal, genital, coccygeal, and perianal pain, often linked to identifiable organic conditions such as anal fistulae, infections, or hemorrhoids. When CPP lacks an identifiable cause, however, it presents a complex challenge for both patients and clinicians, requiring knowledge beyond gynecology alone. Neuropelveology aids in diagnosing and treating CPP outside traditional gynecological approaches. The Neuropathic Pain Special Interest Group of the International Association for the Study of Pain defines neuropathic pain as stemming from lesions or diseases affecting the nervous system's sensory function. Confirming neuropathic pain is challenging, resulting in guidelines that classify it as "definite," "probable," or "possible." Women frequently face abdominal or pelvic issues that can lead to probable neuropathic pain, with procedures like cesarean or vaginal deliveries resulting in chronic pain and gynecologic procedures posing a risk. Diagnosing pelvic neuropathic pain is complicated by various differential diagnoses for abdominal or pelvic pain, making clinical examination essential for reliable detection, more so than other diagnostic tools like electrical testing, MRI, or x-rays. Tissues in these areas are innervated by sensory fibers that process pain through distinct sensory fiber types. Acute pelvic pain often includes nonspecific symptoms like nausea, vomiting, and leukocytosis. Chronic pelvic pain (CPP) is characterized by noncyclic discomfort lasting over six months, often arising from gynecologic conditions such as adenomyosis, endometriosis, leiomyomas, adhesions, and pelvic congestion syndrome. Ultrasound (US) is effective for diagnosing these conditions. Diagnosing neuropathic pain requires understanding its role in central nervous system changes rather than just peripheral issues. This pain can affect sleep and mood, highlighting the need for therapies addressing brain-related problems to improve quality of life. Central sensitization may necessitate treatment with neuromodulatory medications despite peripheral symptoms. These medications, commonly classified as antidepressants, anticonvulsants, and sedative-hypnotics, are effective for managing neuropathic pain. This review examined essential Gynecological health topics relevant to women's well-being, covering neuropathic pelvic pain, acute pelvic pain, endometriosis, fibroid pain, and ovarian cysts, along with insights into diagnosis and management. It also addresses dysmenorrhea, vulvodynia, interstitial cystitis, pelvic organ prolapse, birth control, STI screening, menstrual disorders, and Gynecological surgeries, highlighting critical aspects of women's health needs. Neuropathic Pelvic Pain and Gynecological examination Previous pelvic or abdominal surgery, in addition to obstetric occurrences, constitutes substantial risk variables. Inguinal hernia repair, low abdominal trocar or drainage incisions, and Pfannenstiel incisions may possibly injure the genitofemoral and ilioinguinal nerves. Interventions in the perineum, rectum, or obstetric procedures may damage the pudendal nerve or its branches. Moreover, pelvic operations and thrombosis may impair pelvic vein distribution, potentially leading to pelvic varicose veins and increasing the risk of vascular entrapment or sacral compartment syndrome. Patients with varicose veins have a heightened susceptibility to the development of pelvic varicose veins. Clinical exams include the evaluation of the genital organs by colposcopy, supported by vaginal culture, urinalysis, vaginal pH assessment, Pap smear, and excision of aberrant vulvar areas. Rectovaginal palpation assesses the pectoral and lower sacral root nerves. The sacrum spinal nerves L5 and S1 cannot be reached through vaginal or rectal probing; however, the pudendal spinal nerve is palpable dorsomedial to the sciatic spine. The lower sacral nerve may be accessed at the sacrum, within a few millimeters from the midline. Abdominopelvic neuropathic pain frequently arises after surgical procedures, with gynecologists frequently seeing it in atypical instances, such as whenever endometriosis affects pelvic neurons or when involuntary discomfort compresses nerves such as the obturator, pudendal, or lateral femoral cutaneous branches. Consultation with neurologists is advised for prevalent fascial or distant extremities neuropathies. A comprehensive surgical history, particularly about previous transverse abdominal incisions, is crucial owing to the risk of nerve injury. Gynecologists generally examine mechanical sensitivity but should also consider ...
