Yael Sela, Keren Grinberg, Rachel Nissanholtz Gannot
We proposed that integrating disease-specific diagnosis with pain-mechanism phenotyping would provide a more clinically useful framework for explaining symptom persistence and selecting care.
Abstract Introduction and Hypothesis Chronic pelvic pain (CPP) often persists despite repeated organ-directed evaluation and treatment. We proposed that integrating disease-specific diagnosis with pain-mechanism phenotyping would provide a more clinically useful framework for explaining symptom persistence and selecting care. Methods A structured narrative review was conducted using PubMed/MEDLINE, PubMed Central, the Cochrane Library, professional guidelines, journal websites, and reference lists. English-language literature published from January 2020 to May 2026 was prioritized, with earlier seminal sources included for foundational concepts. Results Evidence indicates that CPP commonly reflects interacting nociceptive, neuropathic, nociplastic, musculoskeletal, psychological, sexual, and social contributors. Central sensitization and nociplastic pain may help explain disproportionate, widespread, or persistent pain, while pelvic floor dysfunction, distress, catastrophizing, fear-avoidance, sleep disturbance, and sexual pain can intensify disability. Current guidelines and reviews support comprehensive assessment, pelvic floor physical therapy when indicated, pain neuroscience education, psychological pain interventions, sexual counseling, disease-specific treatment, and coordinated multidisciplinary follow-up. Treatment matching should be based on dominant mechanisms and patient-prioritized outcomes rather than diagnosis or pain intensity alone. Conclusions A mechanism-based biopsychosocial approach validates CPP as real while broadening therapeutic targets. Combining rigorous disease evaluation with pain phenotyping may reduce fragmented care and improve function, intimacy, quality of life, and patient–clinician communication.