Chronic Pelvic Pain Literature Review: Developing the FIGO- IPPS “R U MOVVING SOMe” classification system for female chronic pelvic pain.
Lamvu G, Villegas-Echeverri JD, Allaire C, et al. July 2025
As part of our ongoing review of the literature, her we examine a landmark FIGO/IPPS consensus paper proposing a new framework for diagnosing chronic pelvic pain as a multifactorial regional pain syndrome rather than a single disease.
Why This Paper Matters
As part of our ongoing review of important medical publications shaping pelvic health care, we are highlighting studies and consensus papers that may meaningfully change how clinicians think about diagnosis and treatment.
Some publications confirm what experienced clinicians already suspect. Others redefine the conversation entirely.
This 2025 international consensus paper from the International Federation of Gynecology and Obstetrics (FIGO) and the International Pelvic Pain Society (IPPS) falls into the second category.
For decades, chronic pelvic pain (CPP) has been approached as a diagnostic puzzle requiring identification of a single underlying cause. But for many patients, that model has proven incomplete—and often frustrating.
This publication proposes a major conceptual shift: chronic pelvic pain should be understood less as a single disease process and more as a complex regional pain syndrome with overlapping contributors.
That’s an important change, and one worth understanding.
Article Summary
The Problem with the Traditional Diagnostic Model
Historically, chronic pelvic pain evaluations often focused on finding one diagnosis that explained the patient’s entire pain experience.
Common diagnostic targets included:
Endometriosis
Interstitial cystitis / bladder pain syndrome
Irritable bowel syndrome
Pelvic floor dysfunction
Neuropathic pain disorders
But the expert panel behind this publication recognized that many patients do not fit neatly into a single diagnosis. Instead, they often present with multiple coexisting pain contributors that interact with one another.
This helps explain why some patients continue experiencing pain even after surgery, hormonal treatment, or other targeted interventions.
What the Authors Proposed
To address this problem, the authors developed a standardized classification framework called R U MOVVING SOMe, created through an international Delphi consensus process involving clinicians, researchers, patient advocates, specialty societies, and individuals with lived chronic pelvic pain experience.
The framework categorizes contributors to chronic pelvic pain across 12 domains:
R – Reproductive
U – Urinary
M – Musculoskeletal
O – Other
V – Vulvovaginal
V – Vascular
I – Idiopathic
N – Neurologic
G – Gastrointestinal
S – Sensitization / Nociplastic pain
O – Overlapping pain conditions
Me – Mental health
Rather than forcing clinicians to choose one explanation, this model acknowledges that chronic pelvic pain is often multifactorial.
Key Clinical Takeaways
The publication reinforces several important ideas:
1. Chronic pelvic pain is frequently not a single-organ disorderPelvic pain may arise from reproductive, urinary, musculoskeletal, neurologic, gastrointestinal, or central pain-processing contributors simultaneously.
2. Central sensitization mattersThe paper specifically recognizes nociplastic pain and altered pain processing as meaningful contributors to persistent symptoms.
3. Mental health is part of the diagnostic framework—not an afterthoughtPsychological distress, trauma history, anxiety, and pain amplification mechanisms are acknowledged as relevant modifiers of pain experience.
4. Surgery is not always the answerThe presence of overlapping pain conditions may explain why some patients do not improve after anatomically focused interventions.
Why This Changes Practice
Perhaps the most meaningful shift is philosophical.
The old diagnostic question was:
“What single diagnosis explains this pain?”
The newer question becomes:
“What combination of overlapping contributors is shaping this patient’s pain experience?”
That is a far more clinically useful framework—and one that better reflects what many pelvic pain specialists see in practice.
Bottom Line
This FIGO/IPPS consensus paper represents an important evolution in chronic pelvic pain care.
It validates a more comprehensive, systems-based approach to diagnosis and provides clinicians with a practical framework for organizing complex patient presentations.
For patients who have struggled to fit their symptoms into a single diagnosis, that shift may be especially meaningful.
Lamvu G, Villegas-Echeverri JD, Allaire C, et al. Developing the FIGO-IPPS “R U MOVVING SOMe” classification system for female chronic pelvic pain. Int J Gynecol Obstet. 2025;171(3):550-565. doi:10.1002/ijgo.70522
Comments