The role of Pelvic neurophysiology testing in evaluating a neurological cause for Chronic Pelvic Pain in Females

Gupta J1, Malladi P1, Sykora R2, Pakzad M1, Simeoni S1, Panicker J1

Research Type

Clinical

Abstract Category

Pelvic Pain Syndromes

Abstract 515
Open Discussion ePosters
Scientific Open Discussion Session 104
Friday 19th September 2025
10:50 - 10:55 (ePoster Station 6)
Exhibition
Pain, Pelvic/Perineal Pain, other Neuropathies: Peripheral
1. Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery/ University College London Hospital Trust,London, 2. Department of Urology, University Hospital, Ostrava, Czech Republic
Presenter
J

Jagrati Gupta
Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery/ University College London Hospital Trust,London
Links

Abstract

Hypothesis / aims of study 
Chronic pelvic pain ( CPP) affects 26% of the female population all over the world. ( 1)  Due to its complex etiology, it poses a major challenge to health care providers.  Many times due to limited availability of neurodiagnostic tests, patients with neurological cause of pelvic pain are often missed. 

This study aims to assess the role of a pelvic neurological assessment  in women presenting with CHronic pelvic pain. 

Objectives-
1.	To review the findings of the neurological examination and  pelvic neurophysiology testing in females presenting with CPP. 
2.	To assess the association between findings in the Neurological examination and pelvic neurophysiology testing 
3.	To establish the relationship between pelvic visceral organs dysfunction and pelvic neurophysiology findings in females with CPP.
Study design, materials and methods 
A retrospective study assessing neurological and neurophysiology findings in women with a clinical diagnosis of CPP.  All women had general and pelvic neurological examination by a neurologist documenting sensory and motor changes. A clinical scientist, unaware of the neurological findings, performed a battery of standardised pelvic neurophysiology tests that included
a)  Assessment of afferent S2-S4 innervation by evaluating the S2- S4 dermatomal sensory evoked potentials (dSEPs) 
b) Pudendal SEP tudy 
c) Assessment of sacral S2-S4 reflex arc by Bulbocavernosus reflex 
d) Anal sphincter and /or Urethral sphincter EMG 
Pelvic visceral organ dysfunction was assessed through history covering patients experiencing lower urinary tract and/or bowel symptoms except isolated constipation. 

The clinical scientist subsequently correlated all clinical symptoms noted in the clinical records with neurological and neurophysiological findings
Results 
Women with CPP referred for pelvic neurophysiology (Jan 2022–Dec 2024) were recruited. See Figure 1. 

Mean age: 54.4 years; mean symptom duration: 6.7 years. 

Neurological causes were excluded.

15 (68%) had Chronic Primary Pain  Syndrome ( CPPPS) , 7 (32%) had Chronic Secondary Pain Syndrome ( CSPPS ) (5 mesh-related, 2 post-endometriosis surgery). ( 2) 

Abnormal PNPT ( Pelvic NeuroPhysiology Test) and NE ( Neurological Examination)  were found in 64% (14/22), with 73% (16/22) concordance. See figure 2. 

CPPPS: 53% (8/15) had abnormal PNPT; CSPPS: 85% (6/7) had abnormal PNPT.

16/22 reported LUTS/bowel symptoms; 69% (11/16) had abnormal PNPT.

Pain duration was longer in abnormal PNPT cases (10 years vs. 3.4 years).
 
Pudendal nerve involvement was seen in 43% (6/14) of abnormal PNPT cases.
Interpretation of results 
These results suggest a high prevalence of abnormal pelvic neurophysiology in women with chronic pelvic pain, particularly in those with secondary pain related to prior surgeries or mesh insertion. The strong concordance between neurological examination and neurophysiology testing supports their combined utility in assessment. Additionally, longer pain duration was associated with abnormal neurophysiology, highlighting potential neurogenic contributions to symptom persistence.
Concluding message 
1) Pelvic neurophysiology testing greatly enhanced the detection of neurological abnormalities in women with CPP. 
2) 53%  of females with CPPPS without any previous neurological disease were found to have objective evidence of neurological injury affecting either the pudendal nerve or sacral roots. Intrapelvic nerve entrapment is suspected, representing potential therapeutic targets.
3) More than 70% showed concordance between neurological examination and neurophysiological findings. However, neurological examination findings were nonspecific, highlighting the need for objective tests such as pelvic neurophysiology for the neurological phenotyping of chronic pelvic pain.
4) The Queen Square pelvic neurophysiology protocol can be easily implemented in any centre that offers neurophysiology services, and patients tolerate the tests well
Figure 1 Flow chart showing number of patients ( n) included in the study and their subdivision into CPPPS and CSPPS
Figure 2 Pie diagram showing abnormalities detected in Neurological examination and Pelvic neurophysiology test and finding concordance between the two tests.
References 
  1. Chronicpelvicpain:ACOGPracticeBulletin, number 218. Obstet Gynecol. 2020;135(3):e98-e109. doi:10.1097/AOG.0000000000003716 .
  2. EAU Guidelines. Edn. presented at the EAU Annual Congress, Madrid 2025. ISBN 978-94-92671-29-5.
Disclosures
Funding No grants or funding taken for this study Clinical Trial No Subjects Human Ethics Committee Ethics approval REC reference: 24/LO/0638. Helsinki Yes Informed Consent Yes
16/07/2025 16:55:05