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The Neuroanatomy of Female Pelvic Pain

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Pain in Women

Abstract

The female pelvis is innervated through primary afferent fibers that course in nerves related to both the somatic and autonomic nervous systems. The somatic pelvis includes the bony pelvis, its ligaments, and its surrounding skeletal muscle of the urogenital and anal triangles, whereas the visceral pelvis includes the endopelvic fascial lining of the levator ani and the organ systems that it surrounds such as the rectum, reproductive organs, and urinary bladder. Uncovering the origin of pelvic pain patterns created by the convergence of these two separate primary afferent fiber systems – somatic and visceral – on common neuronal circuitry in the sacral and thoracolumbar spinal cord can be a very difficult process. Diagnosing these blended somatovisceral pelvic pain patterns in the female is further complicated by the strong descending signals from the cerebrum and brainstem to the dorsal horn neurons that can significantly modulate the perception of pain. These descending systems are themselves significantly influenced by both the physiological (such as hormonal) and psychological (such as emotional) states of the individual further distorting the intensity, quality, and localization of pain from the pelvis.

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Acknowledgments

The authors would like to thank Dawn Whalen for her work on the illustrations.

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Authors and Affiliations

  1. Department of Anatomy, College of Osteopathic Medicine, University of New England, Biddeford, ME, USA

    Frank H. Willard Ph.D. & Mark D. Schuenke Ph.D.

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  1. Frank H. Willard Ph.D.
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  1. Spaulding Rehabiliation Hospital, Nashua Street 125, Boston, 02114, Massachusetts, USA

    Allison Bailey

  2. , Departments of Anesthesia, Neurology, Cr, Beth Israel Deaconness Medical Center, H, One Brookline Place, Suite 105, Brookline, 02445-7294, USA

    Carolyn Bernstein

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Willard, F.H., Schuenke, M.D. (2013). The Neuroanatomy of Female Pelvic Pain. In: Bailey, A., Bernstein, C. (eds) Pain in Women. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-7113-5_2

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