Position of the Ibero-American Society of Neurourology and Urogynecology (SINUG) on the Treatment of Musculoskeletal Phenotype in Chronic Pelvic Pain Syndrome

Given the high prevalence of the musculoskeletal component in chronic pelvic pain syndrome (CPPS), and the need for improved understanding of its management among healthcare providers, we aimed to review the available evidence addressing musculoskeletal management in primary CPPS. The SINUG (Iberoamerican Society of Neurourology and Urogynecology) has designated a multidisciplinary panel including urologists, gynecologists, physiatrists/rehabilitation specialists, and physiotherapists, all with recognized clinical and academic expertise in the field. The development process followed a structured, multi-step methodology inspired by modified Delphi procedures and current guideline-development standards. The musculoskeletal phenotype of CPPS requires multimodal interventions including behavioural, physical, and psychological aspects, combined with multidisciplinary oral or invasive treatments. Isolated interventions tend to have limited effectiveness, and the active participation of the patient is required. Thus, treatment should be delivered by specialized physiotherapists trained not only in the musculoskeletal component, but also in the psychological mechanisms underlying this pain process. They must also be prepared to incorporate future therapies that demonstrate scientific efficacy in the management of CPPS. Direct communication between physiotherapists and urologists, gynaecologists, colorectal surgeons, and rehabilitation specialists is essential to coordinate and implement all interventions in this multidisciplinary therapeutic plan. As in all chronic pain processes, referrals of CPPS patients to physiotherapy should occur without delay. SINUG considers physiotherapy an indispensable therapeutic option within the multidisciplinary treatment of CPPS, not only when a musculoskeletal phenotype is identified, but also when the patient develops a secondary, self-perpetuating painful contracture of the pelvic floor in other phenotypes. • The musculoskeletal phenotype of chronic pelvic pain syndrome requires multimodal conservative management addressing behavioural, physical, and psychological domains, integrated with phenotype-directed medical or procedural care when indicated. • Treatment should be delivered by specialized pelvic floor physical therapists trained not only in the musculoskeletal contributors to pain, but also in psychological mechanisms and central nervous system contributions to chronic pain. They must be capable of applying behavioural, physical, and psychological strategies within a multimodal framework to improve pain, quality of life, and sexual function. • The collaborative involvement of the rehabilitation physician, urologist, or gynecologist and the pelvic floor physical therapist is essential. Clinical and scientific research supports that pelvic floor physical therapy delivered within a multidisciplinary, multimodal care pathway is both safe and effective. • SINUG supports specialized training, terminological standardization, and evidence-based integration of emerging therapies for chronic pelvic pain syndrome, and considers pelvic floor physical therapy an indispensable component of its multidisciplinary management.