Chronic Pelvic Pain (CPP) is a complex and often debilitating condition that significantly impacts quality of life. Its diverse symptoms and intricate biological and psychological mechanisms highlight why multimodal and multidisciplinary approaches are widely recommended for CPP management. Hypnotherapy is an underutilized treatment for patients with CPP, despite widespread dissatisfaction with pharmacological options. Though research on psychological approaches has had mixed results, there's emerging evidence that hypnosis may be effective. A few case studies and controlled trials have shown its potential to not only modulate pelvic pain but also help restore a patient's overall quality of life, including hedonic functions like sexual pleasure. This review explores the available research on hypnotherapy for various urogenital pain syndromes. While preliminary findings are promising, they are limited by the lack of standardized interventions and the heterogeneity of the studies. More research is needed, specifically in the form of well-designed randomized controlled trials using validated measures for pain, sexual satisfaction, and quality of life.

This study aims to evaluate and compare the clinical effectiveness of endovascular re-intervention versus conservative medical therapy in patients with persistent or recurrent venous-origin chronic pelvic pain (CPP) after initial endovascular embolization for pelvic venous disorders (PeVDs).

Sacrotuberous ligament (STL) ossification is an exceptionally rare condition that may lead to pudendal nerve entrapment through mechanical compression within the pelvic region. Pudendal nerve entrapment is frequently underdiagnosed despite causing significant neuropathic symptoms and functional impairment. We present a case of pudendal nerve entrapment secondary to STL ossification that was successfully managed conservatively. A 50-year-old male patient presented with chronic right-sided hip and perineal pain associated with burning sensation, foreign body sensation, sensory disturbances, and erectile dysfunction. Symptoms were aggravated by prolonged sitting and partially relieved by standing. Physical examination demonstrated reduced superficial sensation in the perineal region. Pelvic radiography revealed partial ossification of the right sacrotuberous ligament, while three-dimensional computed tomography confirmed the extent and morphology of the ossified structure. No additional pelvic or spinal pathology was identified. The patient was treated conservatively with ultrasound-guided corticosteroid injections administered at three-month intervals over a one-year period, combined with activity modification and specialized seating support. Progressive clinical improvement was observed, with complete resolution of pain, sensory symptoms, and erectile dysfunction. At two-year follow-up, the patient remained asymptomatic without evidence of recurrence. This case highlights STL ossification as a rare but clinically important cause of pudendal nerve entrapment and chronic perineal pain. Careful clinical assessment and appropriate imaging are essential for accurate diagnosis. Although surgical treatment has been described in isolated cases, conservative management may provide substantial symptomatic relief and should be considered a first-line therapeutic approach in selected patients.

Complex perianal fistulizing Crohn's disease may progress to a functionally end-stage anorectum characterized by refractory proctitis, fixed anorectal stenosis/stricture, cavitating or recurrent pelvic sepsis, and complex branching fistulas, where repeated local salvage offers diminishing returns. This narrative review synthesizes predominantly observational evidence and consensus guidance on indications, timing, operative strategy, and outcomes of definitive proctectomy/abdominoperineal resection (APR). Decision-making should be structured and time-bound: Define anatomy and occult sepsis with pelvic magnetic resonance imaging (MRI) and examination under anesthesia (EUA), and perform EUA-guided biopsy when malignancy is suspected or surveillance is impractical. When reversibility is uncertain, planned temporary diversion can be used as a 3-6-month trial with explicit targets and stop rules; failure to meet milestones should prompt timely discussion of definitive resection. Operative choice (proctectomy/APR versus proctocolectomy) and dissection plane (close intersphincteric versus wider excision beyond the sphincter complex) should prioritize complete excision of chronically infected tissue and oncologic safety. Because perineal wound morbidity and persistent perineal sinus are common, outcomes depend on preoperative optimization, explicit dead-space/closure planning (primary closure, delayed management, omentoplasty, or flap reconstruction), and a postoperative pathway for early imaging and stepwise salvage. Appropriately timed surgery can provide durable control of sepsis and pain and reduce recurrent urgent interventions.

Endometriosis is a chronic, estrogen-dependent inflammatory disease defined by the presence of endometrial-like tissue outside the uterus, affecting approximately 10% of women of reproductive age as well as a notable proportion of adolescents and postmenopausal patients. Although traditionally considered a pelvic disorder, it is increasingly recognized as a multisystem condition with a broad spectrum of extrapelvic locations and atypical clinical and imaging presentations, which contribute to significant diagnostic delay. This review provides a comprehensive overview of the imaging spectrum of endometriosis beyond the pelvis, emphasizing the central role of magnetic resonance imaging (MRI) in lesion detection, characterization, and preoperative mapping. Particular attention is given to the diverse manifestations of extrapelvic disease, including gastrointestinal, genitourinary, thoracic, musculoskeletal, and neural involvement, each of which may present with nonspecific or misleading findings and mimic other pathological entities. Additionally, uncommon presentations such as infection, malignant transformation, and decidualization, as well as variations across different patient populations, further increase diagnostic complexity. Recognizing these patterns and understanding their imaging features are essential to avoid misdiagnosis and delays in care. A systematic approach combining clinical suspicion, tailored imaging protocols, and structured reporting is key to improving diagnostic accuracy and guiding appropriate management. Greater awareness of the multisystem nature of endometriosis is crucial to optimize patient outcomes and reduce the burden of this frequently underrecognized disease.