Abstract
Objective Although numerous organic conditions may cause chronic pelvic pain (CPP), diagnostic laparoscopy reveals a normal pelvis in many patients with CPP. However, psychological studies yield a high frequency of psychopathology and increased prevalences of chronic stress and traumatic life events, ie, sexual and physical abuse, in women with CPP, suggesting a relationship between posttraumatic stress disorder (PTSD) and CPP. As chronic stress and PTSD have been associated with specific alterations of the hypothalamic-pituitary-adrenal (HPA) axis, we explored stress history, psychopathology and HPA axis alterations in women with CPP.
Method We recruited 16 patients with CPP and 14 painfree, infertile controls from a general hospital where diagnostic laparoscopy was performed. Psychological assessment included standardized interviews on clinical symptoms, abuse experiences and major life events as well as psychometric testing for PTSD-like symptoms and depression. Endocrinological evaluation involved determinations of diurnal salivary cortisol levels and hormonal responses to a corticotropin-releasing factor (CRF) stimulation test (100 microg human CRF) and a low-dose dexamethasone suppression test (0.5 mg).
Results We observed increased prevalences of abuse experiences and PTSD in women with CPP as well as a higher total number of major life events, whereas the mean extent of depression was within the normal range. With respect to endocrine measures, women with CPP demonstrated normal to low diurnal salivary cortisol levels, normal plasma-adrenocorticotropin (ACTH), but reduced salivary cortisol levels in the CRF stimulation test, and an enhanced suppression of salivary cortisol by dexamethasone.
Conclusion Women with CPP demonstrate HPA axis alterations, that partly parallel and partly contrast neuroendocrine correlates of PTSD, but show marked similarity to findings in patients with other stress-related bodily disorders. These findings suggest that a lack of protective properties of cortisol may be of relevance for the development of bodily disorders in chronically stressed or traumatized individuals.
chronic pelvic pain PTSD hypothalamic pituitary adrenal axis, sexual abuse trauma chronic pelvic pain cortisol, HPA axis alterations women chronic pelvic pain, CRF stimulation test pelvic pain cortisol response, dexamethasone suppression test chronic pelvic pain women, posttraumatic stress disorder neuroendocrine correlates pelvic pain, salivary cortisol diurnal levels chronic pelvic pain, abuse history psychopathology unexplained pelvic pain laparoscopy, Heim Hellhammer stress related bodily disorders cortisol, stress related somatic disorders low cortisol HPA dysregulation
PMID 9625218 9625218 DOI 10.1097/00006842-199805000-00017 10.1097/00006842-199805000-00017
Keywords
Adrenocorticotropic Hormone/blood, Adult, Arousal/physiology, Child, Child Abuse/psychology, Child Abuse, Sexual/psychology, Corticotropin-Releasing Hormone, Dexamethasone, Diagnosis, Differential, Female, Humans, Hydrocortisone/metabolism, Hypothalamo-Hypophyseal System/physiopathology, Life Change Events, Pelvic Pain/physiopathology/psychology, Pituitary-Adrenal System/physiopathology, Psychophysiologic Disorders/physiopathology/psychology, Risk Factors, Saliva/metabolism, Somatoform Disorders/physiopathology/psychology, Stress Disorders, Post-Traumatic/diagnosis/physiopathology/psychology, Dexamethasone, Adrenocorticotropic Hormone, Corticotropin-Releasing Hormone, Hydrocortisone