Welcome to the Johns Hopkins Research Program for the Study of Chronic Pain Syndromes in Women Principal Investigator: Ursula Wesselmann, M.D., Ph.D. Associate Professor of Neurology, Neurosurgery, and Biomedical Engineering The Johns Hopkins University School of Medicine Chronic Pelvic Pain Chronic pelvic pain is a common and debilitating problem that can significantly impair the quality of life of a woman. Patients with chronic pelvic pain are usually evaluated and treated by gynecologists, gastroenterologists, urologists, and internists. Often the examination and work-up remain unrevealing and no specific cause of the pain can be identified. In these cases it is important to recognize that pain is not only a symptom of pelvic disease, but that the patient is suffering from a chronic pelvic pain syndrome. Once the diagnosis of chronic pelvic pain is made, treatment should be directed towards symptomatic pain management. Despite the challenge inherent in the management of chronic pelvic pain, effective treatment modalities are available to lessen the impact of pain and offer reasonable expectations of an improved functional status. Interstitial Cystitis Interstitial cystitis is a chronic, painful and often debilitating disease, whose etiology and pathophysiology is largely unknown. It is characterized by pelvic and suprapubic pain, urinary symptoms such as frequency and urgency, and in females often by dyspareunia that may be relieved by voiding. Interstitial cystitis has been considered to belong to the category of chronic pelvic pain syndromes. Current epidemiological studies show that this disease is more common in women than in men. Chronic Urogenital Pain Syndromes Pain syndromes of the urogenital area are well described but poorly understood and under-recognized focal pain syndromes. They include vulvodynia, orchialgia, urethral syndrome, penile pain, prostatodynia, coccygodynia and perineal pain. The etiology of these focal pain syndromes is not known. A specific secondary cause can be identified in a minority of patients, but most often the examination and work-up remain unrevealing. Although these patients are often depressed, rarely are these pain syndromes the only manifestation of a psychiatric disease. Patients presenting with these pain syndromes are best assessed and treated using a multidisciplinary approach. Currently available treatment options are empirical only. Although cures are uncommon, some pain relief can be provided to almost all patients using a multidisciplinary approach including pain medications, local treatment regimens, physical therapy and psychological support, while exercising caution toward invasive and irreversible therapeutic procedures. Vulvodynia Hyperesthesia of the vulva was apparently a well-described entity in American and European gynecological textbooks in the last century. However, despite these early reports the medical literature did not mention vulvar pain again until the early 1980's, when a new interest in this chronic pain syndrome developed. It is not clear, why the chronic vulvar pain syndromes disappeared from the medical literature for almost 100 years. It is possible that the medical community denied and neglected these pain syndromes, or that chronic vulvar pain syndromes indeed were quite rare for a period of time. Further epidemiological studies are necessary to clarify this issues. Vulvodynia is defined as chronic vulvar discomfort. Patients either describe a general discomfort that is involving the whole vulvar area, or the pain is localized to the vulvar vestibule. In the latter case pain is typically evoked by insertion of a tampon or by sexual intercourse. The etiology of vulvodynia is not known. The pain syndrome shares many characteristics with other focal chronic pain syndromes, and therefore vulvodynia has been considered to belong to the group of chronic urogenital pain syndromes.