(精编)【医学教学课件】 盆腔痛综合征教学课件.pptVIP

Pelvic pain syndrome盆腔痛综合征 Persistent or recurrent episodic pelvic pain associated with symptoms suggesting lower urinary tract, sexual, bowel or gynaecological dysfunction. No proven infection or other obvious pathology. 持续性或反复发作性盆腔疼痛伴有提示下尿道功能、性功能、肠功能或妇科功能障碍的症状，而无证实的感染或其它明显的病理变化。 Pathogenesis It is associated with changes in the central nervous system (CNS) that may maintain the perception of pain in the absence of acute injury. 发病机理 与中枢神经系统在无急性损伤时可维持痛感的变化有关。 Pathogenesis These changes may also magnify perception so that nonpainful stimuli are perceived as painful (allodynia) and painful stimuli are perceived as more painful than expected (hyperalgesia). 这些变化也可放大知觉，导致非疼痛性刺激因素引起疼痛（痛觉异常），疼痛性刺激因素引起超常疼痛（痛觉敏感）。 Diagnosis and classification 3.  Vulvar pain syndrome Persistent or recurrent episodic vulvar pain either related to the micturition cycle or associated with symptoms suggestive of urinary tract or sexual dysfunction. There is no proven infection or other obvious pathology. 3.  外阴痛综合征 持续性或反复发作性外阴疼痛，或与排尿周期有关，或伴有提示泌尿道功能或性功能障碍的症状，而无证实的感染或其它明显的病理变化。 Diagnosis and classification 3.  Vulvar pain syndrome It includes, Generalized vulvar pain syndrome: vulval burning or pain that cannot be consistently and tightly localized by point-pressure ‘mapping’ by probing with a cotton-tipped applicator or similar instrument. 包括广泛性外阴痛综合征：外阴灼痛，用棉签等点压探测不能明确定位； Diagnosis and classification 3.  Vulvar pain syndrome Localized vulvar pain syndrome: pain consistently and tightly localized by point-pressure mapping to one or more portions of the vulva (e.g. vestibule). Clinically, pain usually occurs as a result of provocation (touch, pressure or friction). 局限性外阴痛综合征：点压探测能明确疼痛位于外阴（如前庭）的一个或多个部位，临床疼痛常为触、压、摩擦等刺激而触发。 EAU classification of chronic urogenital pain syndromes Treatment Electrical stimulation of “four sacral points” (pudendal nerve) is usually used for prostate pain syndrome and vulvar pain syndrome. Electrical stimulation of “four abdominal points” is usually used for bladde