Central sensitization in patients with chronic pelvic pain resistant to hormonal therapy: A cross‐sectional study of prevalence and clinical correlates in a tertiary referral cohort

INTRODUCTION: Chronic pelvic pain (CPP) affects over 25% of women, with endometriosis being a predominant cause. Central sensitization, particularly pelvic and perineal pain central sensitization (PPCS), is increasingly recognized as a key mechanism in CPP, yet its prevalence and clinical implications across the broader CPP population are underexplored. MATERIAL AND METHODS: The aim was to determine the prevalence of PPCS among patients with CPP unresponsive to hormonal therapy and to assess its impact on symptomatology, analgesic consumption, and quality of life. This retrospective study included 270 consecutive patients presenting for the first time with CPP resistant to hormonal therapy, with or without endometriosis, at a tertiary referral center in France (2024-2025). PPCS was defined using the Convergences PP criteria (score ≥5), and neuropathic-like features using the DN4 score (≥4). Data collected included pain features, comorbid symptoms, quality of life (EHP-5), history of violence, and prior treatments. Multivariable logistic and linear regression analyses were conducted to assess associations with analgesic use and EHP-5 scores. RESULTS: PPCS was present in 54.4% of patients and associated with more severe, multisystem symptoms, including urinary, gastrointestinal, and sexual dysfunction. Patients with PPCS had significantly higher use of strong analgesics (adjusted OR 2.48, 95% CI: 1.05-5.83, p = 0.038) and markedly impaired quality of life (+5.19 EHP-5 points, p < 0.001). A history of gender-based violence, reported by 25.9% of patients, was independently associated with higher analgesic consumption (aOR 2.56, p = 0.028) and was more prevalent among those with PPCS. Neuropathic-like features were associated with lower quality of life but not with increased analgesic use. CONCLUSIONS: These findings support routine screening for central sensitization and trauma history in gynecological practice and advocate for multidisciplinary, trauma-informed, and neuromodulation-focused approaches to CPP management.