Neuropelveology in Endometriosis: Pain Mechanisms, Diagnostic Implications, and Surgical Decision-Making
7 affiliations
- 1Escuela de Ciencias de la Salud, Universidad Anáhuac Puebla, Puebla 72810, Mexico
- 2Centro de Investigación en Ciencias de la Salud (CICSA), Facultad de Ciencias de la Salud Universidad Anáhuac México Norte, Huixquilucan 52786, Mexico
- 3Department of Neurosurgery and Brain Repair, Center of Excellence for Aging and Brain Repair, Morsani College of Medicine, University of South Florida, Tampa, FL 33612, USA
- 4Centro de Rehabilitación e Inclusión Infantil Teletón Estado de México, Tlalnepantla 54010, Mexico
- 5Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México 04510, Mexico
- 6Facultad de Ciencias de la Salud, Universidad Panamericana, Ciudad de México 03920, Mexico
- 7Female Pelvic Surgery Department, Doyenne High Quality and Multidisciplinary Treatment Center for Endometriosis, Ciudad de México 06700, Mexico
Abstract
Endometriosis is a systemic, estrogen dependent neuroinflammatory-mediated disease affecting approximately 10–15% of women of reproductive age. Clinical manifestations include chronic pelvic pain (CPP), dysmenorrhea, dyspareunia, dyschezia, dysuria, and infertility. Endometriosis-associated pain is multifactorial and comprises overlapping nociceptive, neuropathic, and nociplastic pain phenotypes driven by persistent inflammation, neuroangiogenesis, peripheral nerve involvement, and central sensitization (CS). These mechanisms may sustain pain beyond lesion excision, highlighting the importance of pelvic nervous system (PNS) involvement. This narrative review examines the role of neuropelveology (NP) in endometriosis, focusing on pain mechanisms, diagnostic implications, and surgical decision making. NP integrates pelvic neuroanatomy and neurophysiology into structured neurological assessment, pain mapping, symptom localization, and nerve sparing surgery. Current evidence suggests that NP may complement conventional evaluation in selected patients with refractory pain, neuropathic symptoms, discordance between symptom severity and imaging findings, or suspected involvement of the sacral plexus or sciatic nerve. Recognizing distinct pain phenotypes may support individualized treatment planning by balancing lesion excision with neural preservation and identifying patients who may benefit from multidisciplinary pain management, rehabilitation, neurolysis, or neuromodulation. Although current evidence remains limited, NP should be considered a complementary framework rather than a replacement for established endometriosis management. Prospective multicenter studies using standardized diagnostic criteria and long-term functional outcomes are needed to define its clinical utility.
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BibTeX
@article{gabriela2026neuropelveology,
title = {{Neuropelveology in Endometriosis: Pain Mechanisms, Diagnostic Implications, and Surgical Decision-Making}},
author = {Cano-Herrera Gabriela and Ericka Cristina Loza López and Maria Fernanda Bautista Gonzalez and Felipe Esparza Salazar and Tamara Mena Guerrero and Diego De León Vela and Ximena A. van Tienhoven and Emmanuel Simental Aldaba and Patricia Carolina Massieu Pérez and Layra Mena García and Eder Gabriel Rivera Rosas and Dante Carbajal Ocampo and Ramiro Cabrera Carranco and Perla Sofía Vera Hernández and Axel Ranferi García Gaona and Jonathan Fidel Cueto Camara and Javier Iván Armenta Moreno and Ana Gabriela Sierra Brozon},
journal = {Journal of Clinical Medicine},
year = {2026},
month = oct,
doi = {10.3390/jcm15208177},
url = {https://www.mdpi.com/2077-0383/15/20/8177},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Neuropelveology in Endometriosis: Pain Mechanisms, Diagnostic Implications, and Surgical Decision-Making
AU - Cano-Herrera Gabriela
AU - Ericka Cristina Loza López
AU - Maria Fernanda Bautista Gonzalez
AU - Felipe Esparza Salazar
AU - Tamara Mena Guerrero
AU - Diego De León Vela
AU - Ximena A. van Tienhoven
AU - Emmanuel Simental Aldaba
AU - Patricia Carolina Massieu Pérez
AU - Layra Mena García
AU - Eder Gabriel Rivera Rosas
AU - Dante Carbajal Ocampo
AU - Ramiro Cabrera Carranco
AU - Perla Sofía Vera Hernández
AU - Axel Ranferi García Gaona
AU - Jonathan Fidel Cueto Camara
AU - Javier Iván Armenta Moreno
AU - Ana Gabriela Sierra Brozon
PY - 2026
DA - 2026/10/01
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15208177
UR - https://www.mdpi.com/2077-0383/15/20/8177
AB - Endometriosis is a systemic, estrogen dependent neuroinflammatory-mediated disease affecting approximately 10–15% of women of reproductive age. Clinical manifestations include chronic pelvic pain (CPP), dysmenorrhea, dyspareunia, dyschezia, dysuria, and infertility. Endometriosis-associated pain is multifactorial and comprises overlapping nociceptive, neuropathic, and nociplastic pain phenotypes driven by persistent inflammation, neuroangiogenesis, peripheral nerve involvement, and central sensitization (CS). These mechanisms may sustain pain beyond lesion excision, highlighting the importance of pelvic nervous system (PNS) involvement. This narrative review examines the role of neuropelveology (NP) in endometriosis, focusing on pain mechanisms, diagnostic implications, and surgical decision making. NP integrates pelvic neuroanatomy and neurophysiology into structured neurological assessment, pain mapping, symptom localization, and nerve sparing surgery. Current evidence suggests that NP may complement conventional evaluation in selected patients with refractory pain, neuropathic symptoms, discordance between symptom severity and imaging findings, or suspected involvement of the sacral plexus or sciatic nerve. Recognizing distinct pain phenotypes may support individualized treatment planning by balancing lesion excision with neural preservation and identifying patients who may benefit from multidisciplinary pain management, rehabilitation, neurolysis, or neuromodulation. Although current evidence remains limited, NP should be considered a complementary framework rather than a replacement for established endometriosis management. Prospective multicenter studies using standardized diagnostic criteria and long-term functional outcomes are needed to define its clinical utility.
SN - 2077-0383
ER -