Pelviperineology

Chronic pelvic pain (CPP) is a disabling disease which occurs in almost 20% of the female population , decreasing the patient's quality of life . Although the pathogenesis of the disease is still said to be unknown, the main treatments include psychotherapy, drugs, laparoscopic nerve ablation, hysterectomy which implies the removal of the ovary and/or neuromodulation with better results.

Fecal outlet obstruction lowers the quality of life (QOL) of patients with functional constipation. Outlet obstruction may be attributed to the following causes: non relaxation of the puborectalis muscle, anismus, rectal prolapse, rectocele and rectal hyposensitivity.

Pelvic organ prolapse (POP) is a common disease prevalent in 50% of parous women and can significantly reduce patients' quality of life (QoL) . Pelvic organs, such as the uterus, bladder and/or bowel can descend because of failing of the pelvic soft tissue support (ligaments, connective tissue, etc.) and weakness of the vaginal wall.

The International Continence Society (ICS) defines stress urinary incontinence (I.U.E) as the loss of urine that occurs before exertion or exercise or secondary to sneezing or coughing . This situation is related to two physiopathological factors: urethral hypermobility and intrinsic sphincter deficit.

The discovery of the MUS began with two unrelated observations in the mid 1980s. A hemostat applied at midurethra, (so it could not obstruct) controlled urine loss on coughing without bladder neck elevation.

Pelvic organ prolapse (POP) is a relatively common disease, which is described as a loss of anatomical support of the pelvic organs leading to impairment of normal function and diminished quality of life.

Pelvic organ prolapse may occur in up to 50% of parous women. The lifetime risk of undergoing stress urinary incontinence (SUI) or pelvic organ prolapse (POP) surgery by the age of 80 is 20%. An increased prevalence of pelvic organ prolapse is estimated in the coming years.

The precervical arc of Gil-Vernet, was described circa 1951 by Salvador Gil-Vernet, famous Urologist/Anatomist and grandfather of the author.

The underlining causes of chronic pelvic pain in women suffer great variety, with most of the pathology being easily diagnosed and treatable (e.g.: painful bladder syndrome, irritable bowel syndrome, adhesions, adenomyosis, endometriosis, pelvic inflammatory disease etc.). The concern for gynecologists is the idiopathic chronic pelvic pain in women,